ELISE CAROLYN WISE (NPI# 1245265917) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245265917 |
| Entity Type | Individual |
| Full Name | ELISE CAROLYN WISE |
| Credential | NURSE PRACTITIONER |
| Practice Address |
4425 W Olive Ave Suite 200 Glendale AZ 85302-3843 |
| Practice Telephone | 6239379203 |
| Practice Fax Number | 6239300358 |
| Mailing Telephone | 6239379203 |
| Mailing Fax Number | 6239300358 |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2013-11-01 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
AP3213 | AZ | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | FAMILY NURSE PRACTITIONER | AP 1011 | 01 |
| Street Address |
4425 W OLIVE AVE SUITE 200 |
| City | GLENDALE |
| State | AZ |
| Zip Code | 85302-3843 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245773563 | Bonnie Goosic | Counselor | 4425 W Olive Ave, #140 & #200, Glendale, AZ 85302-3843 | 2016-11-18 |
| 1215317169 | Rachel Finegan | Nurse Practitioner | 4425 W Olive Ave, Glendale, AZ 85302-3843 | 2015-06-05 |
| 1124434733 | Jordan Houtz | Social Worker | 4425 W Olive Ave, Suite 200, Glendale, AZ 85302-3843 | 2014-07-02 |
| 1609218239 | Alison Ann Gamez | Counselor | 4425 W Olive Ave, #200, Glendale, AZ 85302-3843 | 2013-07-24 |
| 1275845935 | Glenn Philip Townsend | Nurse Practitioner | 4425 W Olive Ave, #200 & #140, Glendale, AZ 85302-3843 | 2010-07-10 |
| 1023257839 | Josephine K Pierce | Counselor | 4425 W Olive Ave, # 200 & 140, Glendale, AZ 85302-3843 | 2009-02-18 |
| 1871757591 | Krylyn Peters | Counselor | 4425 W Olive Ave, Suite 194, Glendale, AZ 85302-3843 | 2008-07-11 |
| 1215124334 | Erica Chestnut | Counselor | 4425 W Olive Ave, 194, Glendale, AZ 85302-3843 | 2007-10-02 |
| 1659414969 | Empact Suicide Prevention Center Inc | Community/Behavioral Health | 4425 W Olive Ave, #194, Glendale, AZ 85302-3843 | 2007-02-15 |
| 1861561375 | Northwest Organization for Voluntary Alternatives | Community/Behavioral Health | 4425 W Olive Ave, Suite 200, Glendale, AZ 85302-3843 | 2006-11-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235736190 | Tyler Davis LLC | Psychologist | 8607 N 59th Ave Suite C-6, Glendale, AZ 85302 | 2020-10-05 |
| 1679098420 | Sidney M Kingery | Physical Therapist | 5810 W Peoria Ave, Glendale, AZ 85302 | 2017-08-12 |
| 1255877825 | Sonoran Sky Community Services | Community Based Residential Treatment Facility, Mental Illness | 5651 W. Harmont Dr, Glendale, AZ 85302 | 2017-01-06 |
| 1346696382 | Megan Mari Byrne | Chiropractor | 8425 N 61st Dr., Glendale, AZ 85302 | 2016-05-09 |
| 1558742007 | Farzan Mojgani | Dentist | 5929 W. Peoria Ave. Suite 101, Glendale, AZ 85302 | 2015-06-10 |
| 1255757308 | Glendale Modern Dentistry, LLP | Dentist | 5143 West Olive Ave, Suite 140, Glendale, AZ 85302 | 2014-03-13 |
| 1518391341 | Crystal Nicole-marie Whitman | Physical Therapy Assistant | 5411 W. Cinnabar Ave., Glendale, AZ 85302 | 2013-08-28 |
| 1013349570 | A New Leaf | Clinic/Center | 8581 N 61st Ave, Building A, Suite 101-102, Glendale, AZ 85302 | 2013-08-06 |
| 1255602439 | Alicia S Fennemore | Specialist/Technologist | 352 E. Camelback Rd., Suite 102, Phoenix, AZ 85302 | 2012-01-20 |
| 1639306731 | Total Medical Care, LLC | Clinic/Center | 5048 W. Northern Avenue, Suite 105, Glendale, AZ 85302 | 2009-06-16 |
| Find all providers in zip 85302 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477154573 | Marcus Jang | Nurse Practitioner | 1130 E Colorado St Apt 214, Glendale, CA 91205-2092 | 2020-11-04 |
| 1245870799 | Logan Wellness Advanced Nursing Practice Corp | Nurse Practitioner | 655 N Central Ave # 1754, Glendale, CA 91203-1422 | 2020-01-13 |
| 1164901161 | Jesus Alexie Romero | Nurse Practitioner | 6266 W Blackhawk Dr, Glendale, AZ 85308-6798 | 2018-08-09 |
| 1194226928 | Adina Ramona Boros | Nurse Practitioner | 5625 W Bell Rd # 100, Glendale, AZ 85308-3878 | 2018-02-27 |
| 1780107433 | Mark Alan Logan | Nurse Practitioner | 107 1/2 N Columbus Ave, Glendale, CA 91203-2504 | 2017-07-24 |
| 1740702901 | Barbara Browder | Nurse Practitioner | 17505 N Glendale Ave, Glendale, AZ 85308 | 2017-07-10 |
| 1710413208 | Jhaurel Johnson White | Nurse Practitioner | 1510 S Central Ave Ste 600, Glendale, CA 91204-2548 | 2017-05-03 |
| 1508227687 | Lydia Christine Veratti | Nurse Practitioner | 17505 N 79th Ave Ste 203, Glendale, AZ 85308-8726 | 2016-03-16 |
| 1336536960 | Eric Tubat | Nurse Practitioner | 10329 W Montebello Ave, Glendale, AZ 85307-4313 | 2015-04-21 |
| 1760775837 | Susan E Harrell | Nurse Practitioner | 10270 N 67 Ave, Suite 106, Glendale, AZ 85302-1005 | 2011-05-24 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.