Provider Demographics
NPI:1831336692
Name:WISDO, AMY LYNNE (DPM)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:LYNNE
Last Name:WISDO
Suffix:
Gender:F
Credentials:DPM
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Mailing Address - Street 1:11945 GRANDHAVEN DR
Mailing Address - Street 2:SUITE G
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-8091
Mailing Address - Country:US
Mailing Address - Phone:843-357-3762
Mailing Address - Fax:
Practice Address - Street 1:11945 GRANDHAVEN DR
Practice Address - Street 2:SUITE G
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-8091
Practice Address - Country:US
Practice Address - Phone:843-357-3762
Practice Address - Fax:843-357-3772
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-15
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC593213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist