Provider Demographics
NPI:1538482823
Name:WISEMAN, THU NGUYEN (PA)
Entity type:Individual
Prefix:MRS
First Name:THU
Middle Name:NGUYEN
Last Name:WISEMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:THU
Other - Middle Name:THI XUAN
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:622 WEST 168TH STREET, PH1-137
Mailing Address - Street 2:COLUMBIA UNIVERSITY MEDICAL CENTER
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:622 WEST 168TH STREET, PH1-137
Practice Address - Street 2:COLUMBIA UNIVERSITY MEDICAL CENTER
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032
Practice Address - Country:US
Practice Address - Phone:212-305-2995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-01
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0137831363A00000X
NJ25MP00364600363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant