MEDICARE: NICOLE 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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1376960682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE WISE

Provider Business Mailing Address
First Line	:	2659 SW 32ND ST
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33914-4757
Country	:	US
Telephone Number	:	419-277-2533
Fax Number	:

Provider Business Practice Location Address
First Line	:	1406 SE 46TH LN
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-8684
Country	:	US
Telephone Number	:	239-257-1504
Fax Number	:

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

Provider Enumeration Date	:	03/25/2014
Last Update Date	:	03/25/2014

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Directions to “ NICOLE WISE ” Practice Location

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