Basic Information
| Provider Information | |||||||||
| NPI: | 1144429143 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WHEELER | ||||||||
| FirstName: | CORITA | ||||||||
| MiddleName: | MARIE STEINKRUGER | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | P.A.-C, D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1234 NAPIER AVE | ||||||||
| Address2: | SAINT JOSEPH, MI 49085 | ||||||||
| City: | SAINT JOSEPH | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490852112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2699824941 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1234 NAPIER AVE | ||||||||
| Address2: | SAINT JOSEPH, MI 49085 | ||||||||
| City: | SAINT JOSEPH | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490852112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2699824941 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2007 | ||||||||
| LastUpdateDate: | 07/22/2019 | ||||||||
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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 | 363AM0700X | 001827 | IA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207P00000X | 5101022242 | MI | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.