Individual
NICOLLE KAHL WISNIEWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPAS, PA-C
Contact information
Practice address
3801 LAKE OTIS PKWY STE 300, ANCHORAGE, AK 99508-5234
(907) 562-2277
(907) 563-3460
Mailing address
3801 LAKE OTIS PKWY STE 300, ANCHORAGE, AK 99508-5234
(907) 562-2277
(907) 563-3460
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1000
AK
363AS0400X
Surgical Physician Assistant
1000
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1575427
—
AK
05
—
991491900
—
MN
Enumeration date
12/20/2005
Last updated
10/27/2025
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