Provider Demographics
NPI:1013944339
Name:WISE, RITA KATHRYN (ARNP, MSN)
Entity Type:Individual
Prefix:MRS
First Name:RITA
Middle Name:KATHRYN
Last Name:WISE
Suffix:
Gender:F
Credentials:ARNP, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 GREYWOLF RD
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-7573
Mailing Address - Country:US
Mailing Address - Phone:360-582-9233
Mailing Address - Fax:360-582-9233
Practice Address - Street 1:417 GREYWOLF RD
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-7573
Practice Address - Country:US
Practice Address - Phone:360-582-9233
Practice Address - Fax:360-582-9233
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006988207Q00000X, 363LA2200X
WAAP60005736363LF0000X
WARN00158838163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
S82122Medicare UPIN