Individual
ELLIOTT WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
9645 GROVE CIR N STE 200, MAPLE GROVE, MN 55369-2684
(763) 201-8191
(763) 201-8192
Mailing address
9645 GROVE CIR N STE 200, MAPLE GROVE, MN 55369-2684
(763) 201-8191
(763) 201-8192
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
11264
MN
Other
Enumeration date
07/09/2012
Last updated
07/31/2019
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