| NPI | 1417721630 |
|---|---|
| Former Legal Business Name | WISE MIND AND BODY, LLC |
| Entity Type | Organization |
| Authorized Contact | JOANNA WISEMAN CEO/Owner 631-512-9807 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2023-11-08 |
| Last Update Date | 2023-11-13 |