Provider Demographics
NPI:1598844987
Name:WISMER, LEANN K (PA)
Entity Type:Individual
Prefix:
First Name:LEANN
Middle Name:K
Last Name:WISMER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 CAPE MARCO DR
Mailing Address - Street 2:
Mailing Address - City:MARCO ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:34145-6399
Mailing Address - Country:US
Mailing Address - Phone:316-882-9684
Mailing Address - Fax:239-230-2977
Practice Address - Street 1:15044 SANDPIPER LN
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34114-8584
Practice Address - Country:US
Practice Address - Phone:239-529-2142
Practice Address - Fax:239-230-2977
Is Sole Proprietor?:No
Enumeration Date:2006-11-04
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00740363A00000X
363A00000X
FLPA9116891363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant