Provider Demographics
NPI:1407046170
Name:WISE, NANCY JANE
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:JANE
Last Name:WISE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5943
Mailing Address - Country:US
Mailing Address - Phone:208-334-3220
Mailing Address - Fax:208-334-2963
Practice Address - Street 1:341 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5943
Practice Address - Country:US
Practice Address - Phone:208-334-3220
Practice Address - Fax:208-334-2963
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator