Provider Demographics
NPI:1316179179
Name:WIESMAN, CHASIDY SUNSHINE (LPN)
Entity Type:Individual
Prefix:
First Name:CHASIDY
Middle Name:SUNSHINE
Last Name:WIESMAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8176 MILL CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-1651
Mailing Address - Country:US
Mailing Address - Phone:513-860-1806
Mailing Address - Fax:
Practice Address - Street 1:8176 MILL CREEK CIR
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-1651
Practice Address - Country:US
Practice Address - Phone:513-860-1806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.121985-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse