Provider Demographics
NPI:1093767311
Name:WISSER, JOY MARIE (PAC)
Entity Type:Individual
Prefix:MRS
First Name:JOY
Middle Name:MARIE
Last Name:WISSER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8639 N 27TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49083-9735
Mailing Address - Country:US
Mailing Address - Phone:269-629-9917
Mailing Address - Fax:
Practice Address - Street 1:3408 MILLER RD
Practice Address - Street 2:SUITE 301
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001-4111
Practice Address - Country:US
Practice Address - Phone:269-720-9702
Practice Address - Fax:269-350-5030
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601001639363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant