Provider Demographics
NPI:1033881024
Name:WISNIEWSKI, BRITTANY ZUCKERO
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:ZUCKERO
Last Name:WISNIEWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 SABINE ST APT 140
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-8354
Mailing Address - Country:US
Mailing Address - Phone:832-948-3310
Mailing Address - Fax:
Practice Address - Street 1:150 SABINE ST APT 140
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-8354
Practice Address - Country:US
Practice Address - Phone:832-948-3310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA14962363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant