Individual
DEBRA WISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6420 MOUNT AVE, SAINT LOUIS, MO 63121-5717
(314) 458-9602
(314) 282-0158
Mailing address
6420 MOUNT AVE, SAINT LOUIS, MO 63121-5717
(314) 458-9602
(314) 282-0158
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
MO
Other
Enumeration date
10/24/2018
Last updated
10/24/2018
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