Healthcare Provider Details

I. General information

NPI: 1710480538
Provider Name (Legal Business Name): ALLISON WISE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2018
Last Update Date: 06/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 OLD LEXINGTON RD
THOMASVILLE NC
27360
US

IV. Provider business mailing address

2837 JOSH CT
THOMASVILLE NC
27360-8381
US

V. Phone/Fax

Practice location:
  • Phone: 336-472-2000
  • Fax:
Mailing address:
  • Phone: 803-348-0475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number302864
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number102060
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number121611
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: