Individual
MR. RUSSELL J WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
2007 S ZAPATA HWY, LAREDO, TX 78046-6510
(956) 795-8101
(956) 795-8195
Mailing address
2007 S ZAPATA HWY, LAREDO, TX 78046-6510
(956) 795-8101
(956) 795-8195
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
633018
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
081896501
—
TX
05
—
092953101
—
TX
05
—
157631601
—
TX
01
—
157631602
CSHCN
TX
Enumeration date
07/06/2006
Last updated
10/30/2012
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