Individual
MR. GARY LEE WISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
276 COLLEGE ST, WADSWORTH, OH 44281-1575
(330) 573-1761
Mailing address
276 COLLEGE ST, WADSWORTH, OH 44281-1575
(330) 573-1761
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN.099163-M-IV
OH
Other
Enumeration date
08/21/2013
Last updated
08/21/2013
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