Provider Demographics
NPI:1609136217
Name:WISEMAN, DOUGLAS ALLAN (RN)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:ALLAN
Last Name:WISEMAN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMS
Mailing Address - State:IA
Mailing Address - Zip Code:50271-7655
Mailing Address - Country:US
Mailing Address - Phone:515-669-8499
Mailing Address - Fax:
Practice Address - Street 1:306 4TH ST
Practice Address - Street 2:
Practice Address - City:WILLIAMS
Practice Address - State:IA
Practice Address - Zip Code:50271-7655
Practice Address - Country:US
Practice Address - Phone:515-669-8499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA116441163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse