Provider Demographics
NPI:1588624753
Name:WISEMAN, LINDA E (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:E
Last Name:WISEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4033 TALBOT RD S
Mailing Address - Street 2:STE 200
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055
Mailing Address - Country:US
Mailing Address - Phone:425-271-5437
Mailing Address - Fax:425-656-4212
Practice Address - Street 1:4033 TALBOT RD S
Practice Address - Street 2:STE 200
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055
Practice Address - Country:US
Practice Address - Phone:425-271-5437
Practice Address - Fax:425-656-4212
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00028356208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics