Organization
WISE WOMAN WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. RANDI MARY MANN NP (OWNER)
(920) 339-5252
Entity
Organization
Contact information
Practice address
1480 SWAN RD, DE PERE, WI 54115-7966
(920) 339-5252
(920) 632-7652
Mailing address
1480 SWAN RD, DE PERE, WI 54115-7966
(920) 339-5252
(920) 632-7652
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
115-030
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1427016609
NPI
WI
Enumeration date
11/20/2009
Last updated
11/20/2009
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