Individual
DALLAS MCKENZIE WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
3000 SAINT MATTHEWS RD, ORANGEBURG, SC 29118-1442
(803) 533-2200
Mailing address
3000 SAINT MATTHEWS RD, ORANGEBURG, SC 29118-1442
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
217912
SC
367500000X
Certified Registered Nurse Anesthetist
Primary
21068
SC
Other
Enumeration date
11/07/2016
Last updated
04/25/2025
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