Provider Demographics
NPI:1194049254
Name:WISBEY, ANNE M
Entity type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:M
Last Name:WISBEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 5
Mailing Address - Street 2:
Mailing Address - City:WALLOWA
Mailing Address - State:OR
Mailing Address - Zip Code:97885
Mailing Address - Country:US
Mailing Address - Phone:541-886-3039
Mailing Address - Fax:541-886-3039
Practice Address - Street 1:104 SOUTH ALDER ST.
Practice Address - Street 2:
Practice Address - City:WALLOWA
Practice Address - State:OR
Practice Address - Zip Code:97885
Practice Address - Country:US
Practice Address - Phone:541-886-3039
Practice Address - Fax:541-886-3039
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3111521345320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness