Basic Information
Provider Information | |||||||||
NPI: | 1356740104 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | VISKNISKKI | ||||||||
FirstName: | MAGGIE | ||||||||
MiddleName: | ANN | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | VISKNISKKI | ||||||||
OtherFirstName: | MAGGIE | ||||||||
OtherMiddleName: | ANN | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | RN | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | 10918 SUMMERTON DR | ||||||||
Address2: |   | ||||||||
City: | RIVERVIEW | ||||||||
State: | FL | ||||||||
PostalCode: | 335797161 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8137707511 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 8002 KING HELIE BLVD | ||||||||
Address2: |   | ||||||||
City: | NEW PORT RICHEY | ||||||||
State: | FL | ||||||||
PostalCode: | 346531435 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7278414430 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/18/2014 | ||||||||
LastUpdateDate: | 08/18/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0809X | 9331879 | FL | Y |   | Nursing Service Providers | Registered Nurse | Psych/Mental Health, Adult |
No ID Information.