Provider Demographics
NPI:1255625661
Name:WISEMAN, DIANNE S
Entity type:Individual
Prefix:MS
First Name:DIANNE
Middle Name:S
Last Name:WISEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 904
Mailing Address - Street 2:
Mailing Address - City:VERDI
Mailing Address - State:NV
Mailing Address - Zip Code:89439-0904
Mailing Address - Country:US
Mailing Address - Phone:775-742-4368
Mailing Address - Fax:775-322-4460
Practice Address - Street 1:900 W 1ST ST
Practice Address - Street 2:SUITE 200
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-5675
Practice Address - Country:US
Practice Address - Phone:775-742-4368
Practice Address - Fax:775-322-4460
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor