Individual
KELLY R WISNIEWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
75 FRANCIS ST, BOSTON, MA 02115-6110
(617) 732-5636
Mailing address
75 FRANCIS ST, BOSTON, MA 02115-6110
(617) 732-5640
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
09/25/2019
Last updated
02/05/2020
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