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NPI Code Detail

MEDICARE: MRS. WISH MEMA ACNP-BC

MEDICARE: MRS. WISH MEMA ACNP-BC
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
1363LA2100XAcute Care Nurse Practitioner5016025NC
2363L00000XNurse Practitioner5016025NC
3363L00000XNurse Practitioner26NJ15459800NJ
4363LA2100XAcute Care Nurse Practitioner742276TX
5363LA2100XAcute Care Nurse PractitionerAP124737TX
6363L00000XNurse Practitioner23392WI

General Provider Information

NPI Number : 1194141861
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. WISH MEMA ACNP-BC
Provider Business Mailing Address
First Line : PO BOX 845347
Second Line :
City : DALLAS
State : TX
Zip : 75284-5347
Country : US
Telephone Number : 214-645-0624
Fax Number : 214-645-0078
Provider Business Practice Location Address
First Line : 5323 HARRY HINES BLVD
Second Line :
City : DALLAS
State : TX
Zip : 75390-7208
Country : US
Telephone Number : 214-645-0624
Fax Number : 214-645-0078
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2014
Last Update Date : 12/29/2025

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