Most Relevant Information
Provider Data
| NPI Number: | 1003409483 |
| Provider Name: | TYSHAWN WISE |
| Entity Type: | Individual |
| Taxonomy Code: | 3747P1801X |
| Specialty: | Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 02/16/2021 |
| Last Updated: | 02/16/2021 |
Provider Practice Location
2770 S MARYLAND PKWY
LAS VEGAS
NV
891091554
Practice Location Phone/Fax
| Phone: | 7024637779 |
| Fax: |
Provider Mailing Location
2770 S MARYLAND PKWY
LAS VEGAS
NV
891091554
Provider Mailing Phone/Fax
| Phone: | 7024637779 |
| Fax: |