Provider Demographics
NPI:1295000198
Name:WIESINGER, CAROL M
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:M
Last Name:WIESINGER
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 1:3215 POLK RD
Mailing Address - Street 2:
Mailing Address - City:EAST NORRITON
Mailing Address - State:PA
Mailing Address - Zip Code:19403-4030
Mailing Address - Country:US
Mailing Address - Phone:610-933-9483
Mailing Address - Fax:610-933-4080
Practice Address - Street 1:1288 VALLEY FORGE RD
Practice Address - Street 2:UNIT 69
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-2687
Practice Address - Country:US
Practice Address - Phone:610-933-9483
Practice Address - Fax:610-933-4080
Is Sole Proprietor?:No
Enumeration Date:2012-03-12
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN154421L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse