Provider Demographics
NPI:1144721358
Name:WHEATON, THESAURA JENIFER (FNP-C)
Entity type:Individual
Prefix:
First Name:THESAURA
Middle Name:JENIFER
Last Name:WHEATON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4368 ELENA PL
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-3438
Mailing Address - Country:US
Mailing Address - Phone:310-923-4864
Mailing Address - Fax:
Practice Address - Street 1:41210 11TH ST W STE A
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-1447
Practice Address - Country:US
Practice Address - Phone:661-947-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95008441363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner