Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | VP006908M | PA |
NPI | 1003993007 |
---|---|
Provider Name | Mrs. Kimberly R. Wisniewski |
First Address | Johnstown, PA 15901-1632 |
Second Address | Johnstown, PA 15901-1632 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 08/07/2007 |