Individual
KIMBERLY WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
14561 N OUTER 40 RD, CHESTERFIELD, MO 63017-5703
(314) 881-4000
Mailing address
615 LYNN HAVEN LN, HAZELWOOD, MO 63042-3410
(314) 619-6015
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
2007012742
MO
Other
Enumeration date
09/16/2020
Last updated
09/16/2020
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