Active NPI
Angelique Wise, LMT
- Specialist
- Tigard, OR
National Provider Identifier
1598058786
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- LMT#17875
- Practice address
- 14340 SW 80TH PL
Tigard, OR 97224-8162 - Phone
- (971) 269-4080
- NPI assigned
- May 20, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | LMT#17875 | OR | Primary |
Addresses
Primary practice location
14340 SW 80TH PL
Tigard, OR 97224-8162
Mailing address
14340 SW 80TH PL
Portland, OR 97224-8162
Phone (971) 269-4080
Other practice location 1
14340 SW 80th Pl
Portland, OR 97224-8162
Phone (971) 269-4080
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LMT#17875 | OR | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1305849600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521244800000",
"number": "1598058786",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14340 SW 80TH PL",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972248162",
"telephone_number": "971-269-4080"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14340 SW 80TH PL",
"city": "TIGARD",
"state": "OR",
"postal_code": "972248162",
"telephone_number": "971-269-4080"
}
],
"practiceLocations": [
{
"address_1": "14340 SW 80th Pl",
"address_purpose": "LOCATION",
"city": "Portland",
"state": "OR",
"postal_code": "972248162",
"country_code": "US",
"telephone_number": "971-269-4080",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WISE",
"first_name": "ANGELIQUE",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-05-20",
"last_updated": "2018-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "OR",
"license": "LMT#17875",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tigard, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.