Provider Demographics
NPI:1033402698
Name:WISSING, HEIDI
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:
Last Name:WISSING
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 1:1575 NE 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PRINEVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97754-2907
Mailing Address - Country:US
Mailing Address - Phone:541-447-2466
Mailing Address - Fax:541-447-6077
Practice Address - Street 1:1575 NE 3RD ST
Practice Address - Street 2:
Practice Address - City:PRINEVILLE
Practice Address - State:OR
Practice Address - Zip Code:97754-2907
Practice Address - Country:US
Practice Address - Phone:541-447-2466
Practice Address - Fax:541-447-6077
Is Sole Proprietor?:No
Enumeration Date:2011-05-16
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0011151183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist