Provider Demographics
NPI:1861050114
Name:WHEELER, LINDSAY RAE (RN)
Entity type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:RAE
Last Name:WHEELER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 N JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-6248
Mailing Address - Country:US
Mailing Address - Phone:217-474-9013
Mailing Address - Fax:
Practice Address - Street 1:40 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-6248
Practice Address - Country:US
Practice Address - Phone:217-474-9013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-02
Last Update Date:2019-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041399870163W00000X
IL0431399870163W00000X
IL041.399870163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse