Active NPI
Lanore Alice Wisz, PTA
- Community Health Worker
- Kennett Square, PA
National Provider Identifier
1205102191
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- 5502003440
- Practice address
- 600 S Broad St
Kennett Square, PA 19348-3346 - Phone
- (855) 497-6449
- NPI assigned
- Mar 26, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | 5502003440 | MI | Primary |
Addresses
Primary practice location
600 S Broad St
Kennett Square, PA 19348-3346
Mailing address
600 S Broad St
Kennett Square, PA 19348-3346
Phone (855) 497-6449
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5502003440 | MI | MD | Community Health Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1332720000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1332720000000",
"number": "1205102191",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "600 S BROAD ST",
"city": "KENNETT SQUARE",
"state": "PA",
"postal_code": "193483346",
"telephone_number": "855-497-6449"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 S BROAD ST",
"city": "KENNETT SQUARE",
"state": "PA",
"postal_code": "193483346",
"telephone_number": "855-497-6449"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WISZ",
"first_name": "LANORE",
"middle_name": "ALICE",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-03-26",
"last_updated": "2012-03-26",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "MI",
"license": "5502003440",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kennett Square, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.