Provider Demographics
NPI:1295075869
Name:WHEELER, CHARLES MCEWEN III (MSN,RN,PNP-BC,CCRN)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:MCEWEN
Last Name:WHEELER
Suffix:III
Gender:M
Credentials:MSN,RN,PNP-BC,CCRN
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Mailing Address - Street 1:215 STRATTON RD
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4621
Mailing Address - Country:US
Mailing Address - Phone:802-855-2027
Mailing Address - Fax:802-855-2053
Practice Address - Street 1:1 GENERAL WING RD
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4681
Practice Address - Country:US
Practice Address - Phone:802-773-9131
Practice Address - Fax:802-773-1551
Is Sole Proprietor?:No
Enumeration Date:2013-02-19
Last Update Date:2015-08-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MARN240316363LP0200X
VT101-0113805363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics