Provider Demographics
NPI:1679096051
Name:WIMER, JESSICA (RN, BSN, IBCLC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:WIMER
Suffix:
Gender:F
Credentials:RN, BSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 LIBERTY LN
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:17536-9774
Mailing Address - Country:US
Mailing Address - Phone:717-344-6496
Mailing Address - Fax:
Practice Address - Street 1:35 LIBERTY LN
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:PA
Practice Address - Zip Code:17536-9774
Practice Address - Country:US
Practice Address - Phone:717-344-6496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-18
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN634993163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant