Individual
ANDREW WISNIEWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
2607 MARA DR, OTTAWA, IL 61350-1053
(815) 228-9865
Mailing address
2607 MARA DR, OTTAWA, IL 61350-1053
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
07/03/2014
Last updated
07/03/2014
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