Provider Demographics
NPI:1316211543
Name:WISEMAN, BRANDI LYNN (DO)
Entity type:Individual
Prefix:MS
First Name:BRANDI
Middle Name:LYNN
Last Name:WISEMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:442 CIVIC CENTER DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-8572
Mailing Address - Country:US
Mailing Address - Phone:207-624-4800
Mailing Address - Fax:207-624-4835
Practice Address - Street 1:442 CIVIC CENTER DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-8572
Practice Address - Country:US
Practice Address - Phone:207-624-4800
Practice Address - Fax:207-624-4835
Is Sole Proprietor?:No
Enumeration Date:2012-03-06
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MEDO2680208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program