Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 1034276 | TX |
NPI | 1093395253 |
---|---|
Provider Name | Hayli Wise |
First Address | Savannah, TX 76227-1582 |
Second Address | Plano, TX 75075-7738 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2021 |
Last Update Date | 12/04/2021 |