Individual
MATT S WISNIEWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
C.R.N.A.
Contact information
Practice address
1101 DECATUR ST, FIRELANDS REGIONAL MEDICAL CENTER, SANDUSKY, OH 44870
(918) 543-1020
(918) 543-2103
Mailing address
PO BOX 190, INOLA, OK 74036-0190
(918) 543-1020
(918) 543-2103
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN178864
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0679841
—
OH
01
—
430070791
RAILROAD MEDICARE
OH
Enumeration date
03/23/2006
Last updated
07/08/2007
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