Provider Demographics
NPI:1194541656
Name:WHEELER, DOROTHY MARIE
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:MARIE
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 1:7440 LA VISTA DR
Mailing Address - Street 2:APT 122
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-4260
Mailing Address - Country:US
Mailing Address - Phone:214-466-3266
Mailing Address - Fax:
Practice Address - Street 1:7440 LA VISTA DR
Practice Address - Street 2:APT 122
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-4260
Practice Address - Country:US
Practice Address - Phone:214-466-3266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-02
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14038172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty