Provider Demographics
NPI:1306959127
Name:WISE, CATHRYN LEE (MD)
Entity type:Individual
Prefix:DR
First Name:CATHRYN
Middle Name:LEE
Last Name:WISE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CATHRYN
Other - Middle Name:LEE
Other - Last Name:SHULER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9818 NE 83RD ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-2986
Mailing Address - Country:US
Mailing Address - Phone:360-604-2267
Mailing Address - Fax:
Practice Address - Street 1:6902 SE LAKE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97267-2148
Practice Address - Country:US
Practice Address - Phone:503-786-1167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD14059207RN0300X
WAMD00038221207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology