Provider Demographics
NPI:1679295497
Name:WISE, TARYN ANNE
Entity type:Individual
Prefix:
First Name:TARYN
Middle Name:ANNE
Last Name:WISE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3141 MANLEY RD APT 204
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-9619
Mailing Address - Country:US
Mailing Address - Phone:419-410-4661
Mailing Address - Fax:
Practice Address - Street 1:3141 MANLEY RD APT 204
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-9619
Practice Address - Country:US
Practice Address - Phone:419-410-4661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide