Provider Demographics
NPI:1306488234
Name:WISMER, GERALDINE B
Entity type:Individual
Prefix:MRS
First Name:GERALDINE
Middle Name:B
Last Name:WISMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1062 LANCASTER AVE SUITE 2
Mailing Address - Street 2:THE POSTPARTUM STRESS CENTER, LLC
Mailing Address - City:ROSEMONT
Mailing Address - State:PA
Mailing Address - Zip Code:19010-1568
Mailing Address - Country:US
Mailing Address - Phone:610-525-7527
Mailing Address - Fax:610-525-3997
Practice Address - Street 1:1062 LANCASTER AVE SUITE 2
Practice Address - Street 2:THE POSTPARTUM STRESS CENTER, LLC
Practice Address - City:ROSEMONT
Practice Address - State:PA
Practice Address - Zip Code:19010-1568
Practice Address - Country:US
Practice Address - Phone:610-525-7527
Practice Address - Fax:610-525-3997
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN165068L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty