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Individual
MEREDITH RAE WISNIEWSKI
Active
Individual
MEREDITH RAE WISNIEWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA053520
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103193413
—
PA
01
—
11900701
CAQH
—
Enumeration date
11/25/2008
Last updated
11/19/2020
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