Provider Demographics
NPI:1659532190
Name:WISE, SARAH
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
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:PO BOX 618
Mailing Address - Street 2:
Mailing Address - City:GREEN SPRINGS
Mailing Address - State:OH
Mailing Address - Zip Code:44836-0618
Mailing Address - Country:US
Mailing Address - Phone:419-463-7441
Mailing Address - Fax:419-637-3777
Practice Address - Street 1:115 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:OAK HABOR
Practice Address - State:OH
Practice Address - Zip Code:43449
Practice Address - Country:US
Practice Address - Phone:419-463-7441
Practice Address - Fax:419-637-3777
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400383070704376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide