Healthcare Provider Details

I. General information

NPI: 1316218696
Provider Name (Legal Business Name): CAROLYN L WISE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2012
Last Update Date: 07/12/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7841 RIDGE MILLS RD
ROME NY
13440-2202
US

IV. Provider business mailing address

7841 RIDGE MILLS RD
ROME NY
13440-2202
US

V. Phone/Fax

Practice location:
  • Phone: 315-334-1294
  • Fax: 315-334-7382
Mailing address:
  • Phone: 315-334-1294
  • Fax: 315-334-7382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number217250-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: