Healthcare Provider Details

I. General information

NPI: 1306488234
Provider Name (Legal Business Name): MRS. GERALDINE B WISMER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2019
Last Update Date: 10/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1062 LANCASTER AVE SUITE 2 THE POSTPARTUM STRESS CENTER, LLC
ROSEMONT PA
19010-1568
US

IV. Provider business mailing address

1062 LANCASTER AVE SUITE 2 THE POSTPARTUM STRESS CENTER, LLC
ROSEMONT PA
19010-1568
US

V. Phone/Fax

Practice location:
  • Phone: 610-525-7527
  • Fax: 610-525-3997
Mailing address:
  • Phone: 610-525-7527
  • Fax: 610-525-3997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN165068L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: