Provider Demographics
NPI:1477802528
Name:WISZ, ELIZABETH DIANE (CRNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DIANE
Last Name:WISZ
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2500 MARYLAND RD STE 400
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1225
Mailing Address - Country:US
Mailing Address - Phone:154-814-1432
Mailing Address - Fax:215-481-6790
Practice Address - Street 1:2701 BLAIR MILL RD STE C
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090
Practice Address - Country:US
Practice Address - Phone:215-443-0660
Practice Address - Fax:215-443-8422
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2019-08-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PASP012323363LW0102X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health