Individual
MR. KENNETH JAMES WYSOCKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD, FNP
Contact information
Practice address
9900 BREN RD E, MINNETONKA, MN 55343-9664
(602) 702-3825
Mailing address
5444 E LEWIS AVE, PHOENIX, AZ 85008-2616
(602) 702-3825
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN068583
AZ
Other
Enumeration date
02/07/2007
Last updated
07/08/2020
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