Provider Demographics
NPI:1982695458
Name:WISE, WAYNE CLINTON (CRNA)
Entity type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:CLINTON
Last Name:WISE
Suffix:
Gender:M
Credentials:CRNA
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Mailing Address - Street 1:660 RIDGE HILL DR
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-6607
Mailing Address - Country:US
Mailing Address - Phone:830-624-7803
Mailing Address - Fax:
Practice Address - Street 1:1305 WONDER WORLD DR STE 105
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7502
Practice Address - Country:US
Practice Address - Phone:512-353-8161
Practice Address - Fax:512-353-8255
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2014-09-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX682283367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered