Basic Information
| Provider Information | |||||||||
| NPI: | 1295075869 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHEELER | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | MCEWEN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | MSN,RN,PNP-BC,CCRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 215 STRATTON RD | ||||||||
| Address2: | |||||||||
| City: | RUTLAND | ||||||||
| State: | VT | ||||||||
| PostalCode: | 057014621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028552027 | ||||||||
| FaxNumber: | 8028552053 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 GENERAL WING RD | ||||||||
| Address2: | |||||||||
| City: | RUTLAND | ||||||||
| State: | VT | ||||||||
| PostalCode: | 057014681 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8027739131 | ||||||||
| FaxNumber: | 8027731551 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/19/2013 | ||||||||
| LastUpdateDate: | 08/31/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | RN240316 | MA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics | 363LP0200X | 101-0113805 | VT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.