Individual
EVELYN WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
57 LEACLIFF LN, WEST SENECA, NY 14224-3517
(716) 845-2300
Mailing address
57 LEACLIFF LN, WEST SENECA, NY 14224-3517
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
F3024671
NY
363LA2200X
Adult Health Nurse Practitioner
F3024671
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02099347
—
NY
Enumeration date
12/19/2006
Last updated
11/15/2021
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