Provider Demographics
NPI:1013780584
Name:WISE, BARBARA ALLEN (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:ALLEN
Last Name:WISE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:BARBARA
Other - Middle Name:ALLEN
Other - Last Name:SHERWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 492309
Mailing Address - Street 2:
Mailing Address - City:KEAAU
Mailing Address - State:HI
Mailing Address - Zip Code:96749-2309
Mailing Address - Country:US
Mailing Address - Phone:916-872-0451
Mailing Address - Fax:
Practice Address - Street 1:15-1659 LOKELANI AVE
Practice Address - Street 2:
Practice Address - City:KEAAU
Practice Address - State:HI
Practice Address - Zip Code:96749
Practice Address - Country:US
Practice Address - Phone:916-872-0451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-4149363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily