Individual
NICHOLE WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
550 UNIVERSITY BLVD, INDIANAPOLIS, IN 46202-5149
(574) 344-9020
Mailing address
430 INDIANA AVE APT 317, INDIANAPOLIS, IN 46202-3242
(574) 344-9020
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10003027A
IN
363A00000X
Physician Assistant
—
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
068010654
MEDICARE PTAN
IN
05
—
300041467
—
IN
01
—
Q00242769
RAILROAD PTAN
IN
Enumeration date
06/17/2020
Last updated
03/03/2026
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