Individual
CRYSTAL LEA WISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
100 TELETECH DR STE 1, MOUNDSVILLE, WV 26041-2790
(304) 231-4115
Mailing address
4 SANDY AVE, MOUNDSVILLE, WV 26041-1020
(304) 231-4115
(304) 221-3013
Taxonomy
Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
Primary
76436
WV
Other
Enumeration date
11/07/2022
Last updated
11/07/2022
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