Individual
COURTNEY WISEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
18144 SECO ST, JAMESTOWN, CA 95327-9498
(209) 984-4820
(209) 984-4825
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-1246
(704) 384-6072
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0010-07098
NC
363A00000X
Physician Assistant
Primary
57620
CA
Other
Enumeration date
02/21/2017
Last updated
12/12/2023
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