Individual
AMANDA BETH WISECUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
3535 SOUTHERN BLVD, KETTERING, OH 45429-1221
(937) 293-8228
(937) 293-8229
Mailing address
102 CANTERBURY DR, DAYTON, OH 45429-1402
(937) 459-7428
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
APRN.CRNA.019806
OH
Other
Enumeration date
12/04/2018
Last updated
12/06/2024
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