Provider Demographics
NPI:1003993007
Name:WISNIEWSKI, KIMBERLY R (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:R
Last Name:WISNIEWSKI
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
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Mailing Address - Street 1:321 MAIN ST
Mailing Address - Street 2:SUITE 5 G
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15901-1632
Mailing Address - Country:US
Mailing Address - Phone:814-535-7721
Mailing Address - Fax:814-535-2105
Practice Address - Street 1:321 MAIN ST
Practice Address - Street 2:SUITE 5 G
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15901-1632
Practice Address - Country:US
Practice Address - Phone:814-535-7721
Practice Address - Fax:814-535-2105
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAVP006908M363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care