Individual
SHAUNA WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
156 THISTLE ST, PRINCETON, WV 24739-5926
(304) 952-0302
Mailing address
156 THISTLE ST, PRINCETON, WV 24739-5926
(304) 952-0302
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
0024184185
VA
363L00000X
Nurse Practitioner
5020634
NC
363LF0000X
Family Nurse Practitioner
0024184185
VA
Other
Enumeration date
05/01/2022
Last updated
02/24/2025
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