Provider Demographics
NPI:1043539323
Name:WISE, VALORIE J (RN, CARN)
Entity Type:Individual
Prefix:MS
First Name:VALORIE
Middle Name:J
Last Name:WISE
Suffix:
Gender:F
Credentials:RN, CARN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10802 QUAIL PLAZA DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-3116
Mailing Address - Country:US
Mailing Address - Phone:405-752-2787
Mailing Address - Fax:405-752-5787
Practice Address - Street 1:10802 QUAIL PLAZA DR
Practice Address - Street 2:SUITE 108
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-3116
Practice Address - Country:US
Practice Address - Phone:405-752-2787
Practice Address - Fax:405-752-5787
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR 0027352163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)