Provider Demographics
NPI:1285931279
Name:WHEELER, JULIE ANN (IDC)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:WHEELER
Suffix:
Gender:F
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 555657
Mailing Address - Street 2:1ST MEDICAL BATTALION, CLR-15, 1ST MLG, MARFORPAC
Mailing Address - City:CAMP PENDLETON
Mailing Address - State:CA
Mailing Address - Zip Code:92055-5657
Mailing Address - Country:US
Mailing Address - Phone:760-725-4912
Mailing Address - Fax:
Practice Address - Street 1:22190 AVENUE E
Practice Address - Street 2:1ST MEDICAL BATTALION, CLR-15, 1ST MLG, MARFORPAC
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92055-5657
Practice Address - Country:US
Practice Address - Phone:760-725-4912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider