Individual
DAVID MICHAEL WISDOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
21601 76TH AVE W, EDMONDS, WA 98026-7507
(425) 640-4000
Mailing address
1713 OVERBROOK LN, RAYMORE, MO 64083-8172
(816) 868-5374
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA61471148
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1138002
NATIONAL COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANTS
—
Enumeration date
09/04/2018
Last updated
10/17/2025
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