Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | SC006008 | PA |
N | 222Z00000X | Podiatrist | SC006008 | PA |
Y | 213ES0131X | Foot Surgery | 592 | SC |
NPI | 1053511253 |
---|---|
Provider Name | Dr. Corinne Marie Wisdo |
First Address | Myrtle Beach, SC 29572-4116 |
Second Address | Myrtle Beach, SC 29572-4116 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2007 |
Last Update Date | 29/01/2015 |