Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 038-009374 | IL |
NPI | 1023205770 |
---|---|
Provider Name | Dr. Heather Wisniewski |
First Address | Glen Ellyn, IL 60137-5839 |
Second Address | Glen Ellyn, IL 60137-5839 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2007 |
Last Update Date | 19/02/2020 |