Provider Demographics
NPI:1780191247
Name:WISEMAN, PAMELA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:WISEMAN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499 JACKSON PIKE STE D
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1399
Mailing Address - Country:US
Mailing Address - Phone:740-441-2958
Mailing Address - Fax:740-441-2947
Practice Address - Street 1:499 JACKSON PIKE STE D
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1399
Practice Address - Country:US
Practice Address - Phone:740-441-2958
Practice Address - Fax:740-441-2947
Is Sole Proprietor?:No
Enumeration Date:2018-01-05
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.021966363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0287656Medicaid