Individual
HEIDI LYNN WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
850 SW 26TH ST, CORVALLIS, OR 97331-8624
(541) 737-9355
Mailing address
3495 BERGMAN PL SE, SALEM, OR 97317-9384
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
2000001491
—
363AM0700X
Medical Physician Assistant
Primary
PA184479
OR
Other
Enumeration date
07/01/2017
Last updated
01/11/2024
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