Provider Demographics
NPI:1154355675
Name:WISE, BARBARA LOUISE (CNP)
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:LOUISE
Last Name:WISE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2351 STANLEY AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45404-1201
Mailing Address - Country:US
Mailing Address - Phone:937-228-0990
Mailing Address - Fax:
Practice Address - Street 1:231 N BREIEL BLVD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042-3807
Practice Address - Country:US
Practice Address - Phone:513-318-1188
Practice Address - Fax:513-318-1189
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 189036363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2027541Medicaid
OHNP25963Medicare PIN
OHNP25961Medicare PIN
OHNP25962Medicare PIN