Provider Demographics
NPI:1124648365
Name:WHEELER, ERIN MELISSA
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:MELISSA
Last Name:WHEELER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:MELISSA
Other - Last Name:HINCKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:777 CLINTON AVE S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-1448
Mailing Address - Country:US
Mailing Address - Phone:585-279-4800
Mailing Address - Fax:
Practice Address - Street 1:1285 FRANCISCAN DR
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:IL
Practice Address - Zip Code:62056-1778
Practice Address - Country:US
Practice Address - Phone:217-324-6112
Practice Address - Fax:217-324-5959
Is Sole Proprietor?:No
Enumeration Date:2020-04-17
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY322013207Q00000X
IL036.162232207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program