Individual
CHRISTINE M WISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10411 W 52ND CIR, SHAWNEE, KS 66203-1811
(913) 636-4409
Mailing address
10411 W 52ND CIR, SHAWNEE, KS 66203-1811
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
17-01026
KS
171W00000X
Contractor
Primary
2005023703
MO
Other
Enumeration date
02/10/2007
Last updated
03/03/2015
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