Individual
AMY R WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
820 VILLAGE WAY STE 200, WACONIA, MN 55387-4612
(952) 442-2163
(952) 456-7895
Mailing address
3500 AMERICAN BLVD W STE 300, BLOOMINGTON, MN 55431-4442
(952) 486-5143
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
14659
MN
Other
Enumeration date
10/27/2015
Last updated
08/14/2025
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