Provider Demographics
NPI:1316489784
Name:WISOR, BRADY (RN)
Entity type:Individual
Prefix:
First Name:BRADY
Middle Name:
Last Name:WISOR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-2301
Mailing Address - Country:US
Mailing Address - Phone:740-592-3091
Mailing Address - Fax:740-775-7855
Practice Address - Street 1:90 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2301
Practice Address - Country:US
Practice Address - Phone:740-592-3091
Practice Address - Fax:740-775-7855
Is Sole Proprietor?:No
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.291228163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRN.291228OtherLICENSE