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NPI Code Detail

MEDICARE: DEBORAH WIMMER CRNP

MEDICARE: DEBORAH WIMMER CRNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0200XPediatric Nurse PractitionerVP000315DPA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
130027031OTHERPAKEYSTONE MERCY HEALTH PLAN
21845164OTHERPABLUE CROSS
32701047000OTHERPAKEYSTONE HEALTH PLAN EAST
41488081OTHERPAAETNA
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1588614267
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBORAH WIMMER CRNP
Provider Business Mailing Address
First Line : 1035 W BERKS ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19122-1909
Country : US
Telephone Number : 610-664-0280
Fax Number :
Provider Business Practice Location Address
First Line : 1035 W BERKS ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19122-1909
Country : US
Telephone Number : 215-765-6690
Fax Number : 215-765-6694
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2006
Last Update Date : 10/16/2008

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