MEDICARE: DEANNE 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	363LF0000X	Family Nurse Practitioner	1058125	TX
2	208100000X	Physical Medicine & Rehabilitation Physician	1058125	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689339608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEANNE WISE

Provider Business Mailing Address
First Line	:	1776 WOODSTEAD CT STE 208
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77380-1480
Country	:	US
Telephone Number	:	877-749-7428
Fax Number	:

Provider Business Practice Location Address
First Line	:	22999 HIGHWAY 59 N
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77339-4412
Country	:	US
Telephone Number	:	281-348-8600
Fax Number	:

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

Provider Enumeration Date	:	11/04/2021
Last Update Date	:	12/03/2025

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Directions to “ DEANNE WISE ” Practice Location

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