Provider Demographics
NPI:1336556935
Name:WISE, ALLISON MARIE (MSN-FNP)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:MARIE
Last Name:WISE
Suffix:
Gender:F
Credentials:MSN-FNP
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:MARIE
Other - Last Name:FOSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN-FNP
Mailing Address - Street 1:1100 GROSSCUP AVE
Mailing Address - Street 2:
Mailing Address - City:DUNBAR
Mailing Address - State:WV
Mailing Address - Zip Code:25064-3120
Mailing Address - Country:US
Mailing Address - Phone:304-768-8811
Mailing Address - Fax:304-768-4072
Practice Address - Street 1:1100 GROSSCUP AVE
Practice Address - Street 2:
Practice Address - City:DUNBAR
Practice Address - State:WV
Practice Address - Zip Code:25064-3120
Practice Address - Country:US
Practice Address - Phone:304-768-8811
Practice Address - Fax:304-768-4072
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN68238NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1336556935Medicaid
WV9156432OtherGROUP MEDICARE
WVB441OtherGROUP MEDICARE
WV3810024049OtherGROUP MEDICAID
WV3810024049OtherGROUP MEDICAID