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General NPI Number Information
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NPI Number | 1710430897
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Entity Type | Individual
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Provider Name | LARYSA LESHELL WISE APRN-CNP
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Gender | Female
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Dates
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Enumeration Date | 07/26/2016
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Last Update Date | 02/19/2025
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Provider Practice Location Address
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Address Line | 2424 E 21ST ST STE 425
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City | TULSA
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State | OK
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Zip | 74114-1727
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Country | US
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Telephone | 918-779-7582
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Fax | 918-779-7587
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Provider Business Mailing Address
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Address Line | 2424 E 21ST ST STE 425
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City | TULSA
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State | OK
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Zip | 74114-1727
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Country | US
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Telephone | 918-779-7582
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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 | F0716709
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License Number State | OK
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