Provider Demographics
NPI:1043594237
Name:WISNER, NICHOLAS MERLE
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:MERLE
Last Name:WISNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2560 BUSINESS PKWY
Mailing Address - Street 2:STE B
Mailing Address - City:MINDEN
Mailing Address - State:NV
Mailing Address - Zip Code:89423-8985
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2560 BUSINESS PKWY
Practice Address - Street 2:STE B
Practice Address - City:MINDEN
Practice Address - State:NV
Practice Address - Zip Code:89423-8985
Practice Address - Country:US
Practice Address - Phone:775-267-9411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner