Individual
JEROME ALLEN WISEHART
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1265 S MILL ST, NASHVILLE, IL 62263-2004
(618) 327-4833
Mailing address
14940 EAST ST, WHITTINGTON, IL 62897-1335
(618) 629-2585
Taxonomy
Speciality
Code
Description
License number
State
237700000X
Hearing Instrument Specialist
Primary
2803
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
270033874009
—
IL
05
—
270033874011
—
IL
Enumeration date
07/30/2006
Last updated
07/09/2007
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