Wise, John David
Wise, John David is an individual health care provider with primary practice located at 2793 Lineville Rd , Green Bay WI 54313-7152. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Wise, John David can be contacted via phone (920) 496-4700.Contact Information
Primary practice address
2793 Lineville Rd
Green Bay WI 54313-7152
Phone: (920) 496-4700
Fax: (920) 496-4705
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | 085.009449 | Illinois |
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | 941 | Wisconsin |
Profile Details
| NPI number | 1093739724 |
|---|---|
| LBN Legal business name | Wise, John David |
| Credentials | Physician Assistant (PA) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 26th, 2006 |
| Last updated | Apr 25th, 2024 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1093739724 | NPPES |
| Wisconsin | MEDICAID | 42989000 |
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