Individual
MIRANDA PAIGE WISENBAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
2918 E WALNUT AVE, DALTON, GA 30721-8724
(706) 529-4600
Mailing address
2918 E WALNUT AVE, DALTON, GA 30721-8724
(706) 529-4633
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN223590
GA
Other
Enumeration date
06/10/2016
Last updated
09/01/2023
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