Provider Demographics
NPI:1063380244
Name:WHEATLEY, MARY ANNE (DNP, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ANNE
Last Name:WHEATLEY
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 S 144TH ST STE 280
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-5252
Mailing Address - Country:US
Mailing Address - Phone:402-745-1145
Mailing Address - Fax:
Practice Address - Street 1:2727 S 144TH ST STE 280
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-5252
Practice Address - Country:US
Practice Address - Phone:402-745-1145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-28
Last Update Date:2025-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE116385363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner