Provider Demographics
NPI:1093189771
Name:WISENER, CHERYL (DIHOM)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:WISENER
Suffix:
Gender:F
Credentials:DIHOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 S BEERSHEBA RD
Mailing Address - Street 2:
Mailing Address - City:CLOVER
Mailing Address - State:SC
Mailing Address - Zip Code:29710-8793
Mailing Address - Country:US
Mailing Address - Phone:803-627-7591
Mailing Address - Fax:
Practice Address - Street 1:433 S BEERSHEBA RD
Practice Address - Street 2:
Practice Address - City:CLOVER
Practice Address - State:SC
Practice Address - Zip Code:29710-8793
Practice Address - Country:US
Practice Address - Phone:803-627-7591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath