Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 111500 | NE |
N | 363LW0102X | Nurse Practitioner - Women's Health | 111500 | NE |
NPI | 1023436920 |
---|---|
Provider Name | Dr. Deborah Wisnieski |
First Address | Omaha, NE 68198-8102 |
Second Address | Omaha, NE 68198-8102 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2014 |
Last Update Date | 18/11/2015 |