Provider Demographics
NPI:1619625662
Name:WISE, BARBIE MARIE
Entity Type:Individual
Prefix:
First Name:BARBIE
Middle Name:MARIE
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 1:3257 SAMUEL RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-3725
Mailing Address - Country:US
Mailing Address - Phone:330-319-3279
Mailing Address - Fax:
Practice Address - Street 1:3257 SAMUEL RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44312-3725
Practice Address - Country:US
Practice Address - Phone:330-319-3279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide