Healthcare Provider Details

I. General information

NPI: 1053053991
Provider Name (Legal Business Name): CHELSE MARIE WISENOR DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2022
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 COAL VALLEY RD
CLAIRTON PA
15025-3704
US

IV. Provider business mailing address

2000 CLIFFMINE RD STE 500
PITTSBURGH PA
15275-1053
US

V. Phone/Fax

Practice location:
  • Phone: 412-466-1125
  • Fax:
Mailing address:
  • Phone: 878-201-3312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberOS024804
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: