| Doctor Name: | KIM WISNESKI |
| NPI Number: | 1093136079 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | R44816 |
| Business Practice Address: | 3701 Sundance St. Los Lunas, NM - 87031 |
| Business Phone Number: | 5058660185 |
| Business Fax Number: | 5058660302 |
| Mailing Address: | 3701 Sundance St., LOS LUNAS |
| State: | NM |
| Postal Code: | 87031 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 12/18/2013 |
| NPI Last Update Date: | 12/18/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WS0200X |
| License Number: | R44816 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |