Individual
NICOLE A. WIZEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
71 HAYNES ST, MANCHESTER, CT 06040-4131
(860) 533-6595
(860) 533-6594
Mailing address
71 HAYNES ST, MANCHESTER, CT 06040-4131
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
3298
CT
363AS0400X
Surgical Physician Assistant
PA5251
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4686907
AETNA
CT
Enumeration date
02/23/2015
Last updated
01/30/2017
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