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General NPI Number Information
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NPI Number | 1689339608
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Entity Type | Individual
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Provider Name | DEANNE WISE
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Gender | Female
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Dates
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Enumeration Date | 11/04/2021
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 22999 HIGHWAY 59 N
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City | KINGWOOD
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State | TX
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Zip | 77339-4412
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Country | US
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Telephone | 281-348-8600
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Fax |
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Provider Business Mailing Address
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Address Line | 1776 WOODSTEAD CT STE 208
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City | THE WOODLANDS
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State | TX
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Zip | 77380-1480
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Country | US
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Telephone | 877-749-7428
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1058125
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 1058125
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License Number State | TX
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