1689725376 NPI number — MS. NANCY CORLEY-WHEELER MN ARNP

Table of content: MS. NANCY CORLEY-WHEELER MN ARNP (NPI 1689725376)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689725376 NPI number — MS. NANCY CORLEY-WHEELER MN ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CORLEY-WHEELER
Provider First Name:
NANCY
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MN ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CORLEY-WHEELER
Provider Other First Name:
NANCY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
ARNP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1689725376
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
608 S G ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TACOMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98405-4625
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-573-1105
Provider Business Mailing Address Fax Number:
253-573-1104

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
608 S G STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98405-4625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-573-1105
Provider Business Practice Location Address Fax Number:
253-573-1104
Provider Enumeration Date:
01/16/2007

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:  AP30001770 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9646704 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: AP30001770 . This is a "ARNP" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com