Individual
KRYSTLE MICHELLE WISNASKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
6812 STATE ROUTE 162 STE 200, MARYVILLE, IL 62062-8562
(618) 288-0900
Mailing address
PO BOX 14369, SAINT LOUIS, MO 63178-4369
(314) 567-6071
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209.020939
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
209.020939
—
IL
Enumeration date
03/03/2020
Last updated
03/17/2025
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