Individual
AMBER J WISEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
208 MAIN STREET, MCINTOSH, SD 57641-0195
(605) 273-4335
(605) 273-4360
Mailing address
PO BOX 195, MC INTOSH, SD 57641-0195
(605) 273-4335
(605) 273-4360
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0656
SD
Other
Enumeration date
06/17/2006
Last updated
02/14/2012
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