Individual
NICKOLAS JUSTIN WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1159 MARKET ST, TACOMA, WA 98402
(253) 552-5786
Mailing address
1159 MARKET ST, TACOMA, WA 98402
(253) 552-5786
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
11/25/2019
Last updated
11/25/2019
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