Individual
KIM WISNESKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3701 SUNDANCE ST., LOS LUNAS, NM 87031
(505) 866-0185
(505) 866-0302
Mailing address
3701 SUNDANCE ST., LOS LUNAS, NM 87031
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
R44816
NM
Other
Enumeration date
12/18/2013
Last updated
12/18/2013
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