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Individual

ALISON NAOMI WHEATLEY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
1090 W PARK PL, COEUR D ALENE, ID 83814-2785
(208) 292-0292
Mailing address
1090 W PARK PL, COEUR D'ALENE, ID 83814
(208) 292-0292

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
5753
AZ
363AM0700X
Medical Physician Assistant
Primary
PA-1365
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
5753
5753
AZ
01
PA-1365
STATE LICENSE
ID
Enumeration date
10/10/2014
Last updated
07/21/2016
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