Provider Demographics
NPI:1598932451
Name:WISE, ROSEMARIE (LVN)
Entity Type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:
Last Name:WISE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:ROSEMARIE
Other - Middle Name:
Other - Last Name:POBLETE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:15200 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-1013
Mailing Address - Country:US
Mailing Address - Phone:510-336-1188
Mailing Address - Fax:
Practice Address - Street 1:2620 26TH AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-1907
Practice Address - Country:US
Practice Address - Phone:510-437-2363
Practice Address - Fax:510-437-2366
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA206237164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse