Individual
MISS NICOLE TESSA WIZEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
17660 UNION TPKE, SUITE 360, FRESH MEADOWS, NY 11366-1526
(718) 460-2300
Mailing address
17660 UNION TPKE, SUITE 360, FRESH MEADOWS, NY 11366-1526
(718) 460-2300
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
08/28/2015
Last updated
08/28/2015
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