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General NPI Number Information
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NPI Number | 1356266407
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Entity Type | Individual
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Provider Name | GENETTE JILL WISE LPN
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Gender | Female
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Dates
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Enumeration Date | 08/10/2026
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Last Update Date | 08/10/2026
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Provider Practice Location Address
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Address Line | 618 N COLLEGE ST
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City | MOUNTAIN HOME
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State | AR
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Zip | 72653-2406
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Country | US
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Telephone | 870-425-1251
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Fax | 870-425-1264
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Provider Business Mailing Address
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Address Line | 171 HARLIN DR
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City | GAINESVILLE
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State | MO
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Zip | 65655-7383
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Country | US
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Telephone |
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 2015039976
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License Number State | MO
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