Most Relevant Information
Provider Data
| NPI Number: | 1003361858 |
| Provider Name: | JEFFERY WISE PMHNP-BC |
| Entity Type: | Individual |
| Taxonomy Code: | 363LP0808X |
| Specialty: | Nurse Practitioner |
| License Number: | 01606596NP-PP |
Most Important Dates
| Enumeration Date: | 08/22/2016 |
| Last Updated: | 01/13/2022 |
Provider Practice Location
1834 NW 25TH AVE APT 504
PORTLAND
OR
972102764
Practice Location Phone/Fax
| Phone: | 9713549242 |
| Fax: |
Provider Mailing Location
1834 NW 25TH AVE APT 504
PORTLAND
OR
972102764
Provider Mailing Phone/Fax
| Phone: | 9713549242 |
| Fax: |