| NPI | 1477164093 |
|---|---|
| Former Name | CARLY WISE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN672559) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN672559) |
| Enumeration Date | 2020-08-17 |
| Last Update Date | 2020-12-16 |