Basic Information
| Provider Information | |||||||||
| NPI: | 1477802528 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WISZ | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | DIANE | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2500 MARYLAND RD STE 400 | ||||||||
| Address2: | |||||||||
| City: | WILLOW GROVE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190901225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1548141432 | ||||||||
| FaxNumber: | 2154816790 | ||||||||
| Practice Location | |||||||||
| Address1: | 2701 BLAIR MILL RD STE C | ||||||||
| Address2: | |||||||||
| City: | WILLOW GROVE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19090 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154430660 | ||||||||
| FaxNumber: | 2154438422 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2012 | ||||||||
| LastUpdateDate: | 08/30/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | SP012323 | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health | 363LX0001X | SP012323 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology |
No ID Information.