Provider Demographics
NPI:1124646237
Name:WISEMAN, JOANNA (APRN, PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:JOANNA
Middle Name:
Last Name:WISEMAN
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 NIMS SPRING DR
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-6461
Mailing Address - Country:US
Mailing Address - Phone:631-512-9807
Mailing Address - Fax:
Practice Address - Street 1:8601 SIX FORKS RD STE 400
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-2965
Practice Address - Country:US
Practice Address - Phone:646-453-6777
Practice Address - Fax:904-390-7398
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5017694363L00000X, 363LP0808X
FLAPRN11022388363LP0808X
SC26568363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner