Individual
JENNIFER RENEE WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
12016
NH
207R00000X
Internal Medicine Physician
Primary
MD192270
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
012016
TUFTS PIN
NH
01
—
01YP05180NH01
ANTHEM ACES PIN
NH
01
—
101115805
DOL W/C PIN
NH
05
—
30203784
—
NH
01
—
30367Y
RAN PIN
NH
01
—
3369774
AETNA PROV #
NH
01
—
5796012
CIGNA PIN
NH
01
—
6000361
HPHC PIN
NH
01
—
P00179641
RR MEDICARE PIN
NH
Enumeration date
09/15/2005
Last updated
02/11/2020
Update your record
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