Individual
JENNIFER RENEE WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2821 DAGGETT AVE STE 200, KLAMATH FALLS, OR 97601-1106
(541) 274-8400
(541) 274-8405
Mailing address
2865 DAGGETT AVE, KLAMATH FALLS, OR 97601-1106
(541) 274-8400
(541) 274-8405
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
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