Individual
MRS. JENNIFER MARIE WYSONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MMS, PA-C
Contact information
Practice address
1111 LIGHTHOUSE LN, GOSHEN, IN 46526-3824
(574) 533-0348
(574) 533-0277
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
085.005306
IL
363A00000X
Physician Assistant
Primary
10003507A
IN
363A00000X
Physician Assistant
—
IL
Other
Enumeration date
12/15/2014
Last updated
08/30/2023
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