Individual
MRS. BONNIE SUSETTE WISDOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
11065 MIDDLEWAY PIKE, CHARLES TOWN, WV 25414-4366
(304) 724-6091
(304) 725-7204
Mailing address
11065 MIDDLEWAY PIKE, CHARLES TOWN, WV 25414-4366
(304) 724-6091
(304) 725-7204
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
0024166327
VA
363LF0000X
Family Nurse Practitioner
Primary
62175
WV
Other
Enumeration date
07/17/2007
Last updated
07/17/2007
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