Individual
COURTNEY JANA WISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
32 RUTGERS DR, NEWARK, NJ 07103-3087
(908) 636-1258
Mailing address
32 RUTGERS DR, NEWARK, NJ 07103-3087
(908) 636-1258
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
26NP07273800
NJ
164W00000X
Licensed Practical Nurse
325202-10
NY
Other
Enumeration date
11/13/2017
Last updated
11/13/2017
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