Individual
MR. JOHN ANTHONY WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
21540 W 11 MILE RD, STE 200, SOUTHFIELD, MI 48076-3843
(248) 352-2000
(248) 352-8800
Mailing address
13033 DIVERSEY ST, DEARBORN, MI 48126-1152
(248) 352-2000
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704323970
MI
363LF0000X
Family Nurse Practitioner
95002731
CA
Other
Enumeration date
09/07/2016
Last updated
10/06/2016
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