Provider Demographics
NPI:1073358768
Name:WHEELER, RONIKA TYRESSE
Entity type:Individual
Prefix:
First Name:RONIKA
Middle Name:TYRESSE
Last Name:WHEELER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4329 PONDS ST NE # NA
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-2037
Mailing Address - Country:US
Mailing Address - Phone:202-749-9690
Mailing Address - Fax:
Practice Address - Street 1:4329 PONDS ST NE # NA
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-2037
Practice Address - Country:US
Practice Address - Phone:202-749-9690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-26
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator