Provider Demographics
NPI:1609229459
Name:WISE, EMILY NICOLE (CNP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:NICOLE
Last Name:WISE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:N
Other - Last Name:HENDRICKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:PO BOX 7527
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-0727
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 S GRANT AVE
Practice Address - Street 2:SUITE 350
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4701
Practice Address - Country:US
Practice Address - Phone:614-566-9160
Practice Address - Fax:614-566-8392
Is Sole Proprietor?:No
Enumeration Date:2016-07-18
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.19185363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily