Provider Demographics
NPI:1932938651
Name:WISE, VANESSA RIVER
Entity type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:RIVER
Last Name:WISE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 SPARROW HILL CT
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-2546
Mailing Address - Country:US
Mailing Address - Phone:443-833-7152
Mailing Address - Fax:
Practice Address - Street 1:11 SPARROW HILL CT
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-2546
Practice Address - Country:US
Practice Address - Phone:443-833-7152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-31
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health