Healthcare Provider Details

I. General information

NPI: 1235572355
Provider Name (Legal Business Name): RHANDI A WISE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2013
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 N ACADIA RD STE 500
THIBODAUX LA
70301-4743
US

IV. Provider business mailing address

604 N ACADIA RD STE 500
THIBODAUX LA
70301-4743
US

V. Phone/Fax

Practice location:
  • Phone: 985-448-1216
  • Fax: 985-446-8765
Mailing address:
  • Phone: 985-448-1216
  • Fax: 985-446-8765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD.306328
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: