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Brenna Christine Wise

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

1111 W 34th St, Suite 200, Austin, TX 78705

PECOS Enrollment

This provider is enrolled in PECOS as BRENNA WISE.

Based on the most recent information from CMS, provider Brenna Christine Wise is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 5 days ago.

Profile Details

Provider ID
1528416450
Provider Type
Individual
Full Name
Wise, Brenna Christine
Credential
NP

Gender
Female
Sole Proprietor
No
Enumeration Date
6/1/2016
Last Updated
9/25/2023

Contact Information

Practice Location

1111 W 34th St, Suite 200, Austin, TX 78705

(512) 324-3405

(512) 458-5446

Mailing Location

1111 W 34th St, Suite 200, Austin, TX 78705

(512) 279-6749

(512) 298-1795

Provider Taxonomies

Code	Description	License
Code 363LF0000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License AP131507 Texas

Provider Identifiers

ID	Description	Issuer
ID 376643801	Description Medicaid	Issuer Unlisted Texas

Brenna Christine Wise

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Hermsdorfer, Lindsay Rae

Calos, Alicia Christine

Elam, Julie Fawn

Roberts, Megan Blair

Davis, Stephanie Kay

Murphy, Emily Marie

Wills, Jessica

Winegar, Rhonda D

Salgado, Genesis

Whipple, Alizabethe