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General NPI Number Information
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NPI Number | 1215605571
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Entity Type | Organization
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Legal Business Name | WISEST HEART, LLC
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Dates
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Enumeration Date | 09/01/2021
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Last Update Date | 09/17/2021
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Provider Practice Location Address
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Address Line | 520 TUGGLE RD
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City | PROSPECT
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State | VA
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Zip | 23960-7919
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Country | US
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Telephone | 434-509-5235
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Fax | 434-223-1713
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Provider Business Mailing Address
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Address Line | 520 TUGGLE RD
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City | PROSPECT
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State | VA
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Zip | 23960-7919
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Country | US
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Telephone | 434-509-5235
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Fax | 434-223-1713
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Authorized Official
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Title or Position | CEO
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Name | CRYSTAL DIONISI WISE
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Credential | OWNER
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Telephone | 434-509-5235
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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