Individual
MS. LINDSEY JOANN WISMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3727 NE MARTIN LUTHER KING JR BLVD, PORTLAND, OR 97212-1112
(503) 775-4931
(503) 788-7285
Mailing address
3727 NE MARTIN LUTHER KING JR BLVD, ATTN: CREDENTIALING, PORTLAND, OR 97212-1112
(503) 775-4931
(503) 788-7285
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
201050205NP
OR
363LW0102X
Women's Health Nurse Practitioner
Primary
201050206NP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1871898544
—
WA
05
—
500631538
—
OR
Enumeration date
01/11/2011
Last updated
08/27/2015
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