Provider Demographics
NPI:1730519729
Name:WHEELER, BLAKE ALAN (TELEMETRY TECH, CNA)
Entity type:Individual
Prefix:MR
First Name:BLAKE
Middle Name:ALAN
Last Name:WHEELER
Suffix:
Gender:M
Credentials:TELEMETRY TECH, CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7701 FLOURISH SPRINGS ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-8212
Mailing Address - Country:US
Mailing Address - Phone:702-372-8963
Mailing Address - Fax:
Practice Address - Street 1:7701 FLOURISH SPRINGS ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-8212
Practice Address - Country:US
Practice Address - Phone:702-372-8963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-12
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV374700000X
NVCNA027667376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician
No376K00000XNursing Service Related ProvidersNurse's Aide