| NPI | 1790856417 |
|---|---|
| Former Name | NANCY MARIE WISE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: NC 300219) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 036587) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2013-03-18 |