Provider Demographics
NPI:1053091264
Name:WISEMAN, DEANNA JEAN (MSN, RN)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:JEAN
Last Name:WISEMAN
Suffix:
Gender:F
Credentials:MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:364 MOUNT OLIVET CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:AIRVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17302-9092
Mailing Address - Country:US
Mailing Address - Phone:410-808-9648
Mailing Address - Fax:
Practice Address - Street 1:5233 KING AVE STE 200
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-4003
Practice Address - Country:US
Practice Address - Phone:410-933-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR195793163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health