Provider Demographics
NPI:1063726222
Name:RASMUSSEN- WISEMAN, LESLEE NOREEN (RN)
Entity type:Individual
Prefix:
First Name:LESLEE
Middle Name:NOREEN
Last Name:RASMUSSEN- WISEMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LESLEE
Other - Middle Name:NOREEN
Other - Last Name:WISEMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:101 E 26TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98421-1108
Mailing Address - Country:US
Mailing Address - Phone:253-597-4550
Mailing Address - Fax:
Practice Address - Street 1:101 E 26TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98421-1108
Practice Address - Country:US
Practice Address - Phone:253-597-4550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-29
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00049261171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator