Provider Demographics
NPI:1558313056
Name:WISEMAN, JENNIFER E (MSN, APN-C)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:E
Last Name:WISEMAN
Suffix:
Gender:F
Credentials:MSN, APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MIDDLESEX MEDICAL GROUP
Mailing Address - Street 2:225 MAY ST STE E
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-3266
Mailing Address - Country:US
Mailing Address - Phone:732-661-2020
Mailing Address - Fax:732-661-2022
Practice Address - Street 1:MIDDLESEX MEDICAL GROUP
Practice Address - Street 2:225 MAY ST STE E
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-3266
Practice Address - Country:US
Practice Address - Phone:732-661-2020
Practice Address - Fax:732-661-2022
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2015-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN09300100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
223170423OtherFEDERAL TAX ID
223170423OtherFEDERAL TAX ID
223170423OtherFEDERAL TAX ID