MEDICARE: CHRISSIE WISE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374J00000X	Doula		TX

General Provider Information

NPI Number	:	1063245108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISSIE WISE

Provider Business Mailing Address
First Line	:	7310 MENCHACA RD # 152193
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-5262
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7310 MENCHACA RD # 152193
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-5262
Country	:	US
Telephone Number	:	512-710-6684
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2024
Last Update Date	:	08/23/2024

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Directions to “ CHRISSIE WISE ” Practice Location

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