Individual
MR. NICHOLAS JOHN OLIVER WISEMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
18111 NORDHOFF ST, NORTHRIDGE, CA 91330-0001
(818) 677-1200
Mailing address
8856 ENCINO AVE, SHERWOOD FOREST, CA 91325-3229
(310) 709-7318
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22
CSUN
CA
Enumeration date
05/20/2018
Last updated
05/20/2018
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