Wisner, Mark Edwin

Wisner, Mark Edwin is an individual health care provider with primary practice located at 4101 S 4Th St Vamc Rm. A541, Leavenworth KS 66048-5014. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Medical, Physician Assistants & Advanced Practice Nursing Providers / Surgical. Physician Assistants & Advanced Practice Nursing Providers / Medical is his primary health care specialty. Wisner, Mark Edwin can be contacted via phone (913) 758-5416.

Contact Information

Primary practice address
4101 S 4Th St Vamc Rm. A541 Leavenworth KS 66048-5014
Phone: (913) 758-5416
Fax: (913) 758-4219
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X PA 15-000385 Kansas
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X PA-15-000385 Kansas

Profile Details

NPI number 1598771586
LBN Legal business name Wisner, Mark Edwin
Credentials PH.D., PA-C
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 31st, 2006
Last updated Sep 23rd, 2010 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1598771586 NPPES
Kansas MEDICAID 100340730A
Kansas Other 426715

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