Basic Information
| Provider Information | |||||||||
| NPI: | 1871556548 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WISNIEWSKI | ||||||||
| FirstName: | JOANNE | ||||||||
| MiddleName: | |||||||||
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| Credential: | N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 292 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | EAST AURORA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140521650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166521560 | ||||||||
| FaxNumber: | 7166520018 | ||||||||
| Practice Location | |||||||||
| Address1: | 292 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | EAST AURORA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140521650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166521560 | ||||||||
| FaxNumber: | 7166520018 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2006 | ||||||||
| LastUpdateDate: | 05/03/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | F340078 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 00021055401 | 01 | NY | UNIVERA | OTHER | 000560610002 | 01 | NY | BC/BS | OTHER | 9512525 | 01 | NY | IHA | OTHER | BA1293 | 01 | NY | FACILITY PIN | OTHER |