Provider Demographics
NPI:1770251241
Name:WYSS, JEAN MARIE
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:MARIE
Last Name:WYSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15116 WITTE RD
Mailing Address - Street 2:
Mailing Address - City:HOAGLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46745-9717
Mailing Address - Country:US
Mailing Address - Phone:260-385-1185
Mailing Address - Fax:
Practice Address - Street 1:11130 PARKVIEW CIRCLE DR # 7
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1735
Practice Address - Country:US
Practice Address - Phone:260-672-4050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28124729A163WX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0800XNursing Service ProvidersRegistered NurseOrthopedic