Individual
BETHANY DANIELLE WISNIEWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
6150 DIAMOND CENTRE CT UNIT 1200, FORT MYERS, FL 33912-7135
(239) 344-9786
Mailing address
3040 OASIS GRAND BLVD APT 2202, FORT MYERS, FL 33916-1607
(561) 779-0610
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA9116636
FL
363AS0400X
Surgical Physician Assistant
Primary
PA9116636
FL
Other
Enumeration date
10/19/2022
Last updated
02/13/2025
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