| Provider / Organization | NPI | Date Certified |
|---|---|---|
| JENA LOIS WISE | 1841711132 | 2023-01-22 |
Jena Lois Wise is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1841711132. Registration indicates Jena Lois Wise is a provider of services with a specialization in Dietary & Nutritional Service Providers, Dietitian, Registered (Dietitian, Registered, ) (All Other Specialties & Provider Types, ) (Dietitian, Registered, Dietary & Nutritional Service Providers)
| Entity Type | Individual |
| Provider Name | Jena Lois Wise PA-C |
| Practice Office Address | 100 SOUTH ST SOUTHBRIDGE, MA US |
| Practice Office Telephone | 5087659771 |
| Mailing Address | 330 BROOKLINE AVE BOSTON, MA 022155400 US |
| Code | Practice | License No State |
|---|---|---|
| 133V00000X PRIMARY | Dietary & Nutritional Service Providers Dietitian, Registered Dietitian, Registered All Other Specialties & Provider Types Dietitian, Registered Dietary & Nutritional Service Providers | 4295
MA |