Individual
KIMBERLY R WISECUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
3186 S MARYLAND PKWY, LAS VEGAS, NV 89109-2306
(702) 961-5000
Mailing address
3186 S MARYLAND PKWY, LAS VEGAS, NV 89109-2306
(801) 915-0546
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
OS019367
PA
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
DO3189
NV
Other
Enumeration date
06/15/2015
Last updated
06/29/2022
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