Provider Demographics
NPI:1588614267
Name:WIMMER, DEBORAH (CRNP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:WIMMER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 W BERKS ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19122-1909
Mailing Address - Country:US
Mailing Address - Phone:610-664-0280
Mailing Address - Fax:
Practice Address - Street 1:1035 W BERKS ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19122-1909
Practice Address - Country:US
Practice Address - Phone:215-765-6690
Practice Address - Fax:215-765-6694
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP000315D363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30027031OtherKEYSTONE MERCY HEALTH PLAN
PA1845164OtherBLUE CROSS
PA2701047000OtherKEYSTONE HEALTH PLAN EAST
PA1488081OtherAETNA
PA1014618380001Medicaid