Provider Demographics
NPI:1689349235
Name:WISEMAN, HOLLY A (ARNP)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:A
Last Name:WISEMAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1631 4TH ST SW
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-1612
Mailing Address - Country:US
Mailing Address - Phone:641-428-6000
Mailing Address - Fax:
Practice Address - Street 1:1631 4TH ST SW
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-1612
Practice Address - Country:US
Practice Address - Phone:641-428-6000
Practice Address - Fax:641-428-6007
Is Sole Proprietor?:No
Enumeration Date:2021-08-14
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA159365363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily