Individual
JAENA J WISNIEWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2945 HAZELWOOD ST STE 310, MAPLEWOOD, MN 55109-1244
(651) 264-1500
Mailing address
2945 HAZELWOOD ST STE 310, MAPLEWOOD, MN 55109-1244
(651) 264-1500
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
52638
MN
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
68895-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ENROLLED
—
MN
Enumeration date
01/24/2007
Last updated
02/18/2025
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