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NPI Code Detail

MEDICARE: MRS. MARISA WISEMAN BCBA

MEDICARE:  MRS. MARISA  WISEMAN  BCBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior AnalystLBA0313NV

General Provider Information

NPI Number : 1548791775
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARISA WISEMAN BCBA
Provider Business Mailing Address
First Line : 2570 OFANTO ST
Second Line :
City : HENDERSON
State : NV
Zip : 89044-1798
Country : US
Telephone Number : 702-816-7059
Fax Number :
Provider Business Practice Location Address
First Line : 5550 W FLAMINGO RD STE C5
Second Line :
City : LAS VEGAS
State : NV
Zip : 89103-0137
Country : US
Telephone Number : 702-816-7059
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2017
Last Update Date : 07/28/2024

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Directions to “ MRS. MARISA WISEMAN BCBA” Practice Location

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