Provider Demographics
NPI:1841516143
Name:WISE, MICHELLE ELIZABETH (DNP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ELIZABETH
Last Name:WISE
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4860 S PALMER RD BLDG 51
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20889-4649
Mailing Address - Country:US
Mailing Address - Phone:301-400-1363
Mailing Address - Fax:301-319-3700
Practice Address - Street 1:4860 S PALMER RD BLDG 51
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-4649
Practice Address - Country:US
Practice Address - Phone:301-400-1363
Practice Address - Fax:301-319-3700
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD199842363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily