Provider Demographics
NPI:1881202745
Name:WISOR, TARYN A (DNP APRN CPNP-PC/AC)
Entity Type:Individual
Prefix:
First Name:TARYN
Middle Name:A
Last Name:WISOR
Suffix:
Gender:F
Credentials:DNP APRN CPNP-PC/AC
Other - Prefix:
Other - First Name:TARYN
Other - Middle Name:
Other - Last Name:MAHAFFEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-356-3568
Mailing Address - Fax:319-384-6295
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-356-3568
Practice Address - Fax:319-384-6295
Is Sole Proprietor?:No
Enumeration Date:2020-07-16
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAC168802363L00000X, 363LP0222X
MO2020019714363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics