Provider Demographics
NPI:1235106170
Name:WISE, ANNE C (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:C
Last Name:WISE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 20TH AVE N
Mailing Address - Street 2:SUITE302
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2131
Mailing Address - Country:US
Mailing Address - Phone:615-340-4655
Mailing Address - Fax:615-340-4596
Practice Address - Street 1:300 20TH AVE N
Practice Address - Street 2:SUITE302
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2131
Practice Address - Country:US
Practice Address - Phone:615-340-4655
Practice Address - Fax:615-340-4596
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD34150174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3851936Medicare ID - Type Unspecified
TNH14664Medicare UPIN