Provider Demographics
NPI:1316096597
Name:WHEELER, CATHRINE J (MD)
Entity type:Individual
Prefix:MRS
First Name:CATHRINE
Middle Name:J
Last Name:WHEELER
Suffix:
Gender:F
Credentials:MD
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 25608
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0608
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:206-568-7043
Practice Address - Street 1:5350 TALLMAN AVE NW STE 301
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-5902
Practice Address - Country:US
Practice Address - Phone:206-320-3335
Practice Address - Fax:206-320-8027
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00045319207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAUS7799799OtherAETNA SPECIALIST PIN
WA3919WHOtherBLUE SHIELD #
WA1316096597Medicaid
WA8447666Medicaid
WA0039581OtherLABOR AND INDUSTRIES #
WA3919WHOtherBLUE SHIELD #