Provider Demographics
NPI:1407021330
Name:FORWARD-WISE, ROBIN LIANNE (MD)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:LIANNE
Last Name:FORWARD-WISE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:515 ENTERPRISE DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LOWELL
Mailing Address - State:AR
Mailing Address - Zip Code:72745-8975
Mailing Address - Country:US
Mailing Address - Phone:479-717-7626
Mailing Address - Fax:479-717-7627
Practice Address - Street 1:515 ENTERPRISE DR
Practice Address - Street 2:SUITE 300
Practice Address - City:LOWELL
Practice Address - State:AR
Practice Address - Zip Code:72745-8975
Practice Address - Country:US
Practice Address - Phone:479-717-7626
Practice Address - Fax:479-717-7627
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE-74572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry