Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | D0932 | SD |
NPI | 1023089596 |
---|---|
Provider Name | Dr. Anne Elizabeth Wiseman |
First Address | Sioux Falls, SD 57106-3520 |
Second Address | Sioux Falls, SD 57106-3520 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2006 |
Last Update Date | 14/03/2018 |