Individual
ELISE CAROLYN WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
4425 W OLIVE AVE, SUITE 200, GLENDALE, AZ 85302-3843
(623) 937-9203
(623) 930-0358
Mailing address
4425 W OLIVE AVE, SUITE 200, GLENDALE, AZ 85302-3843
(623) 937-9203
(623) 930-0358
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP3213
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AP 1011
FAMILY NURSE PRACTITIONER
AZ
Enumeration date
07/11/2006
Last updated
11/01/2013
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