Individual
A MICHELLE WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
739 GALLERIA BLVD STE 112, ROCK HILL, SC 29730-5785
(803) 547-4343
Mailing address
224 AVERY JONES LN APT 202, ROCK HILL, SC 29730-0155
(864) 501-7603
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2787
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SCC1783365
MEDICARE PIN
SC
Enumeration date
03/16/2009
Last updated
11/30/2018
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