Provider Demographics
NPI:1386835932
Name:WISE, SUSAN KAY (CNM)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:KAY
Last Name:WISE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 COPELAND AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54603-3401
Mailing Address - Country:US
Mailing Address - Phone:608-784-5249
Mailing Address - Fax:
Practice Address - Street 1:20 COPELAND AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54603-3401
Practice Address - Country:US
Practice Address - Phone:608-784-5249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife