Provider Demographics
NPI:1710211123
Name:WHEELER, JENNIFER (NNP-BC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:WHEELER
Suffix:
Gender:F
Credentials:NNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 RIVER EXCHANGE DR APT 635
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-4231
Mailing Address - Country:US
Mailing Address - Phone:417-827-0950
Mailing Address - Fax:
Practice Address - Street 1:980 JOHNSON FY RD NE STE 680
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1608
Practice Address - Country:US
Practice Address - Phone:678-990-5824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-01
Last Update Date:2024-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN277110363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal