Healthcare Provider Details

I. General information

NPI: 1801519186
Provider Name (Legal Business Name): DANIEL J WISE RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2022
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 W MIDLAND RD
AUBURN MI
48611-9200
US

IV. Provider business mailing address

821 W MIDLAND RD
AUBURN MI
48611-9200
US

V. Phone/Fax

Practice location:
  • Phone: 989-450-5579
  • Fax:
Mailing address:
  • Phone: 989-450-5579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number4704217949
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: