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General NPI Number Information
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NPI Number | 1033970124
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Entity Type | Organization
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Legal Business Name | WISECHOICE MULTISPECIALTY CLINIC
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Dates
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Enumeration Date | 01/17/2024
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 12410 MILESTONE CENTER DR STE 600
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City | GERMANTOWN
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State | MD
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Zip | 20876-7102
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Country | US
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Telephone | 240-344-2122
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Fax |
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Provider Business Mailing Address
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Address Line | 12410 MILESTONE CENTER DR STE 600
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City | GERMANTOWN
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State | MD
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Zip | 20876-7102
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Country | US
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Telephone | 240-344-2122
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | EVELINE GWAABE
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Credential | PMHNP
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Telephone | 443-367-8686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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