Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1093258006 |
---|---|
Provider Name | Ms. Colleen M. Wisniewski |
First Address | Silver Spring, MD 20901-2426 |
Second Address | Silver Spring, MD 20901-2426 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2016 |
Last Update Date | 17/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1992121669 | GROUP NPI (01) | MD |