person
Dr. Mark Edwin Wisner, PHD,PA-C
Surgical Physician Assistant in Leavenworth, Kansas
NPI 1598771586

Mark Edwin Wisner is a Surgical Physician Assistant based in Leavenworth, KS and is specialized in Surgical. Mark Edwin Wisner practices in Leavenworth, KS and has the professional credentials of PHD,PA-C. The NPI Number for Mark Edwin Wisner is 1598771586 and holds a License No. PA 15-000385 (Kansas).

The current practice location address for Mark Edwin Wisner is 4101 S 4Th St, Leavenworth, KS and can be reached out via phone at 913-758-5416 and via fax at 913-758-4219. You can also correspond with Mark Edwin Wisner through the mailing address at 4101 S 4TH ST, LEAVENWORTH, KS - 66048-5014 (mailing address contact number: 913-758-5416).

Location: 4101 S 4Th St, Leavenworth, KS, 66048-5014
person
Provider Profile Details
NPI Number
1598771586
Provider Name
Mark Edwin Wisner
Credential
PHD,PA-C
Provider Entity Type
Individual
Gender
Male
Address
4101 S 4Th St, Leavenworth, KS, 66048-5014
Phone Number
913-758-5416
Fax Number
913-758-4219
Provider Enumeration Date
07/31/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
100340730A 05 KS
426715 01 KS BLUE CROSS/BLUE SHIELD
institution
Provider Business Practice Location Address Details
Address
4101 S 4Th St
City
State
Zip
66048-5014
Phone Number
913-758-5416
Fax Number
913-758-4219
person
Provider Business Mailing Address Details
Address
4101 S 4Th St
City
State
Zip
66048-5014
Phone Number
913-758-5416
Fax Number
913-758-4219
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Physician Assistant
Speciality
Medical
Taxonomy
License No.
PA-15-000385 (Kansas)
Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Physician Assistant
Speciality
Surgical
Taxonomy
License No.
PA 15-000385 (Kansas)
Definition
Definition to come...
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