Provider Demographics
NPI:1437709516
Name:WISEMAN, ANDREA
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
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 1:3616 N COUNTY ROAD 850 E
Mailing Address - Street 2:
Mailing Address - City:OTWELL
Mailing Address - State:IN
Mailing Address - Zip Code:47564-8990
Mailing Address - Country:US
Mailing Address - Phone:812-582-0490
Mailing Address - Fax:
Practice Address - Street 1:3616 N COUNTY ROAD 850 E
Practice Address - Street 2:
Practice Address - City:OTWELL
Practice Address - State:IN
Practice Address - Zip Code:47564-8990
Practice Address - Country:US
Practice Address - Phone:812-582-0490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-19
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider