Provider Demographics
NPI:1790373595
Name:WISE, WILLIAM L (BSN, RN)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:L
Last Name:WISE
Suffix:
Gender:M
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 WEBBER DR
Mailing Address - Street 2:
Mailing Address - City:TEMPERANCE
Mailing Address - State:MI
Mailing Address - Zip Code:48182-8805
Mailing Address - Country:US
Mailing Address - Phone:419-376-1897
Mailing Address - Fax:
Practice Address - Street 1:543 WEBBER DR
Practice Address - Street 2:
Practice Address - City:TEMPERANCE
Practice Address - State:MI
Practice Address - Zip Code:48182-8805
Practice Address - Country:US
Practice Address - Phone:419-376-1897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN279990163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy