Provider Demographics
NPI:1003096934
Name:WISOTSKY, JOANNA BETH (PA)
Entity Type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:BETH
Last Name:WISOTSKY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:JOANNA
Other - Middle Name:BETH
Other - Last Name:BERNSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:7809 SARDIS RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-2757
Mailing Address - Country:US
Mailing Address - Phone:704-364-4000
Mailing Address - Fax:704-364-4005
Practice Address - Street 1:7809 SARDIS RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28270-2757
Practice Address - Country:US
Practice Address - Phone:704-364-4000
Practice Address - Fax:704-364-4005
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-08
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC363A00000X
NC001000939363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCW72384Medicare UPIN
NCQ50069Medicare UPIN