Individual ProviderTyshawn WiseTechnicianNursing Service Related ProvidersPractice Address2770 S Maryland Pkwy, Las Vegas, NV 89109-1554(702) 463-7779PECOS EnrollmentBased on the most recent information from CMS, provider Tyshawn Wise does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1003409483Provider TypeIndividualFull NameWise, TyshawnGenderMaleSole ProprietorYesEnumeration Date2/16/2021Last Updated2/16/2021Contact InformationPractice LocationPractice Address2770 S Maryland Pkwy, Las Vegas, NV 89109-1554Phone(702) 463-7779FaxUnlisted FaxMailing LocationMailing Address2770 S Maryland Pkwy, Las Vegas, NV 89109-1554Phone(702) 463-7779FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode3747P1801XPrimaryDescriptionTechnicianNursing Service Related ProvidersLicenseUnlisted Issuer