Provider Demographics
NPI:1588423305
Name:WILBER, ALYSE CECELIA (MSN, RN, CRNP, CPNP-)
Entity type:Individual
Prefix:
First Name:ALYSE
Middle Name:CECELIA
Last Name:WILBER
Suffix:
Gender:F
Credentials:MSN, RN, CRNP, CPNP-
Other - Prefix:
Other - First Name:ALYSE
Other - Middle Name:CECELIA
Other - Last Name:MAIDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1232 WILDER ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-4927
Mailing Address - Country:US
Mailing Address - Phone:856-417-2740
Mailing Address - Fax:
Practice Address - Street 1:3500 CIVIC CENTER BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4395
Practice Address - Country:US
Practice Address - Phone:215-590-2208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP029384363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics