Provider Demographics
NPI:1548289424
Name:WISE, HEATHER MARIE (ARNP)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:MARIE
Last Name:WISE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 BARKER AVE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-1509
Mailing Address - Country:US
Mailing Address - Phone:914-949-1199
Mailing Address - Fax:
Practice Address - Street 1:3 BARKER AVE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-1509
Practice Address - Country:US
Practice Address - Phone:914-949-1199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2979312363LA2200X
CT004059363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health