Provider Demographics
NPI:1326597071
Name:WIERMAN, ELISSA M (PA-C)
Entity Type:Individual
Prefix:
First Name:ELISSA
Middle Name:M
Last Name:WIERMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ELISSA
Other - Middle Name:M
Other - Last Name:HANAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:2087 ROUTE 9 STE 9
Mailing Address - Street 2:
Mailing Address - City:SEAVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08230-1148
Mailing Address - Country:US
Mailing Address - Phone:609-486-5150
Mailing Address - Fax:609-486-6798
Practice Address - Street 1:2087 ROUTE 9
Practice Address - Street 2:UNIT 9
Practice Address - City:OCEAN VIEW
Practice Address - State:NJ
Practice Address - Zip Code:08230
Practice Address - Country:US
Practice Address - Phone:609-486-5150
Practice Address - Fax:609-486-6798
Is Sole Proprietor?:No
Enumeration Date:2016-09-22
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00409700363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant