Individual
JENNA DENISE WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3700 SOUTHERN BLVD STE 300, KETTERING, OH 45429-1226
(937) 643-9299
(937) 643-2343
Mailing address
3700 SOUTHERN BLVD STE 300, KETTERING, OH 45429-1226
(937) 643-9299
(937) 643-2343
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.003590
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0075383
—
OH
Enumeration date
09/17/2012
Last updated
11/13/2020
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