1316201866 NPI number — MS. COLETTE LYNN WHEELER PMHNP

Table of content: MS. COLETTE LYNN WHEELER PMHNP (NPI 1316201866)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316201866 NPI number — MS. COLETTE LYNN WHEELER PMHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHEELER
Provider First Name:
COLETTE
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PMHNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316201866
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/27/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
770 N COTNER BLVD
Provider Second Line Business Mailing Address:
STE 208
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68505-2344
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-770-0522
Provider Business Mailing Address Fax Number:
855-787-5418

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
770 N COTNER BLVD
Provider Second Line Business Practice Location Address:
STE 208
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68505-2344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-489-3802
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/29/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  111358 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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