Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1023610136 |
---|---|
Provider Name | Ms. Nicole Wheeler |
First Address | Union City, GA 30291-5500 |
Second Address | Union City, GA 30291-5500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2020 |
Last Update Date | 12/11/2020 |