Provider Demographics
NPI:1932824273
Name:WISER, JORDAN BRYCE
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:BRYCE
Last Name:WISER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:583 SANDUSKY ST
Mailing Address - Street 2:
Mailing Address - City:CONNEAUT
Mailing Address - State:OH
Mailing Address - Zip Code:44030-1771
Mailing Address - Country:US
Mailing Address - Phone:440-228-5578
Mailing Address - Fax:
Practice Address - Street 1:583 SANDUSKY ST
Practice Address - Street 2:
Practice Address - City:CONNEAUT
Practice Address - State:OH
Practice Address - Zip Code:44030-1771
Practice Address - Country:US
Practice Address - Phone:440-228-5578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist