| Provider / Organization | NPI | Date Certified |
|---|---|---|
| SAMANTHA RENEE WISE | 1578179081 | 2021-07-23 |
Samantha Renee Wise is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1578179081. Registration indicates Samantha Renee Wise is a provider of access to adult/geriatric primary care providers services with a specialization in Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner (Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner) (Nurse Practitioner: Adult Health, ) (All Other Specialties & Provider Types, ) (Nurse Practitioner Adult Health, Physician Assistants & Advanced Practice Nursing Providers) (Nurse Practitioner, )
| Registration | PART-B:Y DME:Y HHA:Y PMD:Y |
| Entity Type | Individual |
| Provider Name | Samantha Renee Wise |
| Practice Office Address | 1 MEDICAL CENTER DR MORGANTOWN, WV US |
| Practice Office Telephone | 3045984000 |
| Mailing Address | 511 BURROUGHS ST APT 201 MORGANTOWN, WV 265053390 US |
| Business Telephone | 3044357057 |
| Direct Address [] | [email protected] | Health Information Exchange (HIE) |
| Code | Practice | License No State |
|---|---|---|
| 363LA2200X PRIMARY | Access to Adult/Geriatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Nurse Practitioner: Adult Health All Other Specialties & Provider Types Nurse Practitioner Adult Health Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner | 107473
WV |