Individual
LOLA MUDGISTRATOVA WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
400 S 43RD ST, RENTON, WA 98055-5714
(206) 661-2563
Mailing address
3321 104TH PL SE, EVERETT, WA 98208-4538
(206) 661-2563
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD60963016
WA
Other
Enumeration date
04/07/2017
Last updated
01/31/2025
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