Individual
MR. LARRY C WHEEKER
Active
Individual
MR. LARRY C WHEEKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN, CRNA
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
200160039CRNA
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
031589
CRNA RECERTIFICATION #
OR
01
—
079044214RN
RN LICENSE #
OR
01
—
1407812365
NBMC GROUP NPI NUMBER
OR
05
—
268921
—
OR
01
—
430069427
RR MEDICARE PTAN NUMBER
OR
01
—
CD8723
RR MEDICARE GROUP NUMBER
OR
01
—
R0000WFBTV
MEDICARE GROUP PIN NUMBER
OR
Enumeration date
12/20/2005
Last updated
03/23/2010
Update your record
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