Individual
MR. LARRY C WHEEKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN, CRNA
Contact information
Practice address
1900 WOODLAND DR, COOS BAY, OR 97420-0000
(541) 267-5151
(541) 266-4501
Mailing address
1900 WOODLAND DR, COOS BAY, OR 97420-0000
(541) 267-5151
(541) 266-4501
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
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