Individual
LANORE ALICE WISZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
600 S BROAD ST, KENNETT SQUARE, PA 19348-3346
(855) 497-6449
Mailing address
600 S BROAD ST, KENNETT SQUARE, PA 19348-3346
(855) 497-6449
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
5502003440
MI
Other
Enumeration date
03/26/2012
Last updated
03/26/2012
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