Doctor Name: | MRS. NICOLE M WISNIEWSKI |
NPI Number: | 1992960033 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | 5601005972 |
Business Practice Address: | 205 S Bradley Hwy Rogers City, MI - 497792137 |
Business Phone Number: | 9897342052 |
Business Fax Number: | 9897343490 |
Mailing Address: | Po Box 427, HILLMAN |
State: | MI |
Postal Code: | 497460427 |
Phone Number: | 9893562197 |
Fax Number: | 9893566524 |
NPI Enumeration Date: | 07/28/2008 |
NPI Last Update Date: | 01/21/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 5601005972 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |