MEDICARE: JESSICA WISSE

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
1	374J00000X	Doula	BD61610578	WA

General Provider Information

NPI Number	:	1033917901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA WISSE

Provider Business Mailing Address
First Line	:	2011 HOPE VALLEY RD
Second Line	:
City	:	ELTOPIA
State	:	WA
Zip	:	99330-9716
Country	:	US
Telephone Number	:	509-531-0193
Fax Number	:

Provider Business Practice Location Address
First Line	:	2011 HOPE VALLEY RD
Second Line	:
City	:	ELTOPIA
State	:	WA
Zip	:	99330-9716
Country	:	US
Telephone Number	:	509-531-0193
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2025
Last Update Date	:	03/05/2025

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Directions to “ JESSICA WISSE ” Practice Location

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