Individual
KELLY JEAN WISNIEWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGNP
Contact information
Practice address
100 PORT WASHINTON BLVD, ROSLYN, NY 11576
(516) 390-9640
Mailing address
55 FRANKEL RD, MASSAPEQUA, NY 11758-7260
(516) 780-2096
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
312048
NY
Other
Enumeration date
03/27/2025
Last updated
03/27/2025
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