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Individual
VANESSA WISSINGER
Active
Individual
VANESSA WISSINGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1179277
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103983798
—
PA
01
—
MA062805
MEDICAL PHYSICIAN ASSISTANT LICENSE
PA
Enumeration date
11/29/2021
Last updated
04/15/2022
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