Provider Demographics
NPI:1316017205
Name:WHEELER, WENDY MARIE (ARNP, CNM)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:MARIE
Last Name:WHEELER
Suffix:
Gender:F
Credentials:ARNP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20038 NE 192ND ST
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98077-8845
Mailing Address - Country:US
Mailing Address - Phone:425-788-8110
Mailing Address - Fax:
Practice Address - Street 1:10808 NE 145TH ST
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011
Practice Address - Country:US
Practice Address - Phone:206-296-9814
Practice Address - Fax:206-296-9826
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004427363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9621806Medicaid
WAAP30004427OtherARNP
WARN00108981OtherRN
WAMW1427601OtherDEA
WARN00108981OtherRN