| Doctor Name: | JAMIE R WISEMAN |
| NPI Number: | 1023394970 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MD |
| License Number: | 3956-850 |
| Business Practice Address: | 230 E Marydale Ave Suite 1 Soldotna, AK - 996697648 |
| Business Phone Number: | 9072623119 |
| Business Fax Number: | 9072629290 |
| Mailing Address: | Po Box 2949, SOLDOTNA |
| State: | AK |
| Postal Code: | 996692949 |
| Phone Number: | 9072607303 |
| Fax Number: | 9072607358 |
| NPI Enumeration Date: | 10/24/2011 |
| NPI Last Update Date: | 04/29/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | 3956-850 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WI |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |