Provider Demographics
NPI:1225896319
Name:WISEHART, MICHELLE (BA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:WISEHART
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:JOHNSON, CULLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNA, ASSOCIATES
Mailing Address - Street 1:610 HUNTERS RUN ST APT 102
Mailing Address - Street 2:
Mailing Address - City:WATFORD CITY
Mailing Address - State:ND
Mailing Address - Zip Code:58854-3329
Mailing Address - Country:US
Mailing Address - Phone:701-609-0224
Mailing Address - Fax:
Practice Address - Street 1:709 4TH AVE NE
Practice Address - Street 2:
Practice Address - City:WATFORD CITY
Practice Address - State:ND
Practice Address - Zip Code:58854-7628
Practice Address - Country:US
Practice Address - Phone:701-334-2381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator