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General NPI Number Information
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NPI Number | 1942342126
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Entity Type | Individual
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Provider Name | IRENE MANALISAY WISE FNP RN
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Gender | Female
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 710 N BEAVER ST BUILDING 6
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-3100
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Country | US
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Telephone | 928-527-4325
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Fax | 928-527-4327
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Provider Business Mailing Address
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Address Line | 710 N BEAVER ST BUILDING 6
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-3100
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Country | US
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Telephone | 928-527-4325
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Fax | 928-527-4327
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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 | AP4241
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License Number State | AZ
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