Courtney Wiseman, PA
Physician Assistant in Jamestown, CA. Individual provider (NPI-1).
NPI number1144769332
StatusActive
Last updated in NPPESDec 12, 2023
Details
- NPI
- 1144769332
- Entity type
- Individual (NPI-1)
- Name
- Courtney Wiseman
- Credential
- PA
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Feb 21, 2017
- Certification date
- Dec 12, 2023
- Last updated
- Dec 12, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | 57620 | CA | Yes |
| 363A00000X | Physician Assistant | 0010-07098 | NC |
Practice location
18144 Seco StJamestown, CA 95327-9498
Phone 209-984-4820 · Fax 209-984-4825
Mailing address
Po Box 60447Charlotte, NC 28260-0447
Phone 704-384-1246 · Fax 704-384-6072
Other practice locations
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