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General NPI Number Information
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NPI Number | 1174419642
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Entity Type | Individual
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Provider Name | LISA C WISE AGNP-C
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Gender | Female
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Dates
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Enumeration Date | 06/13/2025
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Last Update Date | 10/27/2025
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Provider Practice Location Address
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Address Line | 98 MOSIER PKWY
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City | BROOKVILLE
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State | OH
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Zip | 45309-1750
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Country | US
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Telephone | 937-833-4103
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Fax | 937-833-3147
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Provider Business Mailing Address
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Address Line | 3008 JORDAN RD
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City | WEST ALEXANDRIA
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State | OH
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Zip | 45381-9710
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Country | US
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Telephone | 937-474-8966
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | APRN.CNP.0039475
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License Number State | OH
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