Basic Information
| Provider Information | |||||||||
| NPI: | 1093952418 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WHEELER | ||||||||
| FirstName: | SUSANNE | ||||||||
| MiddleName: | CLARE | ||||||||
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| Credential: | CNS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 221 S 6TH ST | ||||||||
| Address2: | |||||||||
| City: | TERRE HAUTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 478074214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122320564 | ||||||||
| FaxNumber: | 8122424518 | ||||||||
| Practice Location | |||||||||
| Address1: | 1530 N 7TH ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | TERRE HAUTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 478071057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122423109 | ||||||||
| FaxNumber: | 8122423990 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2009 | ||||||||
| LastUpdateDate: | 07/29/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364S00000X | 28093785A | IN | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | 364SA2100X | 71002954A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Acute Care |
No ID Information.