MEDICARE: LATANYA IDELLA WISE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	253Z00000X	In Home Supportive Care Agency
2	171M00000X	Case Manager/Care Coordinator
3	251S00000X	Community/Behavioral Health Agency
4	376J00000X	Homemaker

General Provider Information

NPI Number	:	1992662464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATANYA IDELLA WISE

Provider Business Mailing Address
First Line	:	PO BOX 3032
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43607-0032
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1120 HORACE ST STE G13
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43606-4737
Country	:	US
Telephone Number	:	419-909-2332
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/07/2026
Last Update Date	:	02/17/2026

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