Provider Demographics
NPI:1336639871
Name:WISEMAN, HAILEY ANNE
Entity Type:Individual
Prefix:
First Name:HAILEY
Middle Name:ANNE
Last Name:WISEMAN
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 1:401 SIERRA MAR LOOP
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-3544
Mailing Address - Country:US
Mailing Address - Phone:512-909-1824
Mailing Address - Fax:
Practice Address - Street 1:401 SIERRA MAR LOOP
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-3544
Practice Address - Country:US
Practice Address - Phone:512-909-1824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX374364543747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant