Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jack Larry Wisdom, CSA

Individual provider Registered Nurse · NPI 1376968750

Jack Larry Wisdom, CSA is a Registered Nurse in Paradise, California. Practices as a sole proprietor. Licensed in California and Tennessee.

Licensed in
CA, TN
In the registry since
2014
Specialties on file
2

Practice location Address checks out

5974 Pentz Rd
Paradise, CA 95969-5509
Phone: (530) 876-7903
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Registered Nurse (primary) Taxonomy 163W00000X · Licence 718316 (CA)
Registered Nurse Taxonomy 163W00000X · Licence 96534 (TN)

Record details

NPI number1376968750
Entity typeIndividual (Type 1)
GenderMale
Credentials CSA
Sole proprietorYes
NPI enumeratedFebruary 21, 2014
Last updated in NPPESFebruary 21, 2014
Mailing address261 Tranquil Dr, Paradise, CA 95969-3707

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