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Individual

MR. ROBERT EUGENE WISE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
195 E FIDDLERS CANYON RD, UNIT 14, CEDAR CITY, UT 84720-8744
(435) 559-3136
Mailing address
195 E FIDDLERS CANYON RD, UNIT 14, CEDAR CITY, UT 84720-8744
(435) 559-3136

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
5586107-4406
UT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
86924214
NM
01
P00469890
RR MEDICARE
NM
Enumeration date
03/08/2007
Last updated
07/30/2008
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