Provider Demographics
NPI:1376618181
Name:WISE, SHARON G (APRN-BC)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:G
Last Name:WISE
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 WREN ST
Mailing Address - Street 2:
Mailing Address - City:BARNWELL
Mailing Address - State:SC
Mailing Address - Zip Code:29812-1527
Mailing Address - Country:US
Mailing Address - Phone:803-259-3399
Mailing Address - Fax:803-259-4477
Practice Address - Street 1:154 WREN ST
Practice Address - Street 2:
Practice Address - City:BARNWELL
Practice Address - State:SC
Practice Address - Zip Code:29812-1527
Practice Address - Country:US
Practice Address - Phone:803-259-3399
Practice Address - Fax:803-259-4477
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN725363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0393Medicaid
SCAA17478698Medicare PIN
SCNP0393Medicaid