Individual
TAMARA WISEMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
22 S GREENE ST, BALTIMORE, MD 21201-1544
(410) 328-6716
Mailing address
308 AMMUNITION AVE, ODENTON, MD 21113-2663
(443) 867-2824
Taxonomy
Speciality
Code
Description
License number
State
363LN0005X
Critical Care Neonatal Nurse Practitioner
Primary
R167944
MD
Other
Enumeration date
11/05/2020
Last updated
11/05/2020
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