Individual
AMANDA TUYET-ANH WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
5161 HARRY HINES BLVD, DALLAS, TX 75235-7707
(214) 648-4898
Mailing address
5161 HARRY HINES BLVD, DALLAS, TX 75235-7707
(214) 648-4898
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
667387
TX
208100000X
Physical Medicine & Rehabilitation Physician
OL60865446
WA
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
12925107-1204
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OL60865446
MEDICAL LICENSE NUMBER
WA
Enumeration date
05/11/2017
Last updated
08/07/2023
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