Provider Demographics
NPI:1073076220
Name:WISHART, JOANNA LEMM (FNP)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:LEMM
Last Name:WISHART
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 ENCINA AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-2343
Mailing Address - Country:US
Mailing Address - Phone:650-853-0321
Mailing Address - Fax:
Practice Address - Street 1:33 ENCINA AVE STE 103
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-2343
Practice Address - Country:US
Practice Address - Phone:650-853-0321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-12
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX140775363LF0000X
CA95026505363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily