Provider Demographics
NPI:1801227392
Name:WISE, NATALIE SAUNDERS (FNP)
Entity Type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:SAUNDERS
Last Name:WISE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 FOX CV
Mailing Address - Street 2:
Mailing Address - City:HAUGHTON
Mailing Address - State:LA
Mailing Address - Zip Code:71037-9383
Mailing Address - Country:US
Mailing Address - Phone:318-537-0769
Mailing Address - Fax:
Practice Address - Street 1:4075 COPPER RIDGE DR
Practice Address - Street 2:
Practice Address - City:TRAVERSE
Practice Address - State:MI
Practice Address - Zip Code:49684-4796
Practice Address - Country:US
Practice Address - Phone:321-946-8970
Practice Address - Fax:231-946-1730
Is Sole Proprietor?:No
Enumeration Date:2013-12-09
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN123613163W00000X
LAAP07420363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse