Individual
CLARA DENISE WISENER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
720 S CLARK AVE, REPUBLIC, WA 99166
(509) 775-0233
(509) 775-8029
Mailing address
PO BOX 312, REPUBLIC, WA 99166-0312
(509) 775-0233
(509) 775-8029
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA00017276
WA
Other
Enumeration date
02/28/2007
Last updated
07/08/2007
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