Individual
MRS. NICOLE M WISNIEWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1465 E PARKDALE AVE, MANISTEE, MI 49660-9709
(231) 398-1000
(989) 340-1214
Mailing address
10850 E TRAVERSE HWY, SUITE 4400, TRAVERSE CITY, MI 49684-1364
(231) 346-6800
(989) 340-1214
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5601005972
MI
Other
Enumeration date
07/28/2008
Last updated
10/28/2016
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