Provider Demographics
NPI:1922352293
Name:WISEMAN, ANGELA R (RN, BSN)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:R
Last Name:WISEMAN
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:R
Other - Last Name:KEES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:200 E FREMONT ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-2336
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:360-804-2569
Practice Address - Street 1:200 E FREMONT ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-2336
Practice Address - Country:US
Practice Address - Phone:360-804-2984
Practice Address - Fax:360-804-2569
Is Sole Proprietor?:No
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60015740163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool