Individual
NICOLE LEE WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
800 WASHINGTON ST, BOSTON, MA 02111-1552
(703) 300-4069
Mailing address
76 FLINT ST, SOMERVILLE, MA 02145-4021
(703) 300-4069
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
4609
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/19/2020
Last updated
01/23/2024
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