Provider Information for 1366198889
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KATHERINE WISE
Sex: Female
NPI: 1366198889
Last Updated: 2022-02-23
Certification Date: 2022-02-23
Certification Date: 2022-02-23
Details
Name | Value | ||||||||
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NPI | 1366198889 | ||||||||
Enumeration Date | 2022-02-23 | ||||||||
NPI Type | NPI-1 Individual | ||||||||
Sole Proprietor | YES | ||||||||
Status | Active | ||||||||
Mailing Address | 1726 KINGSLEY AVE STE 2 ORANGE PARK, FL 32073-4411 United States Phone: 904-278-5644 | Fax: | ||||||||
Primary Practice Address | 1726 KINGSLEY AVE ORANGE PARK, FL 32073-4463 United States Phone: 904-278-5644 | Fax: | ||||||||
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