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General NPI Number Information
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NPI Number | 1306959127
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Entity Type | Individual
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Provider Name | CATHRYN LEE WISE MD
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Gender | Female
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6902 SE LAKE RD SUITE 100
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City | MILWAUKIE
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State | OR
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Zip | 97267-2148
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Country | US
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Telephone | 503-786-1167
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Fax |
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Provider Business Mailing Address
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Address Line | 9818 NE 83RD ST
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City | VANCOUVER
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State | WA
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Zip | 98662-2986
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Country | US
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Telephone | 360-604-2267
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | MD14059
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | MD00038221
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License Number State | WA
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