Individual
MS. SHARON R. WISSLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
1506 W REYNOLDS ST, PONTIAC, IL 61764
(815) 844-6123
(815) 884-7851
Mailing address
1506 W REYNOLDS ST, PONTIAC, IL 61764
(815) 844-6123
(815) 884-7851
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209004260
IL
363LA2200X
Adult Health Nurse Practitioner
209004260
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05732097
BCBS GROUP NUMBER
IL
01
—
085507
HEALTH ALLIANCE
IL
01
—
833230
MEDICARE GROUP #
—
Enumeration date
06/01/2006
Last updated
02/28/2011
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