Provider Demographics
NPI:1164128724
Name:WISNIEWSKI, HANNAH KATHRYN
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:KATHRYN
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 1:23 BUFFALO GROVE PL
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-9462
Mailing Address - Country:US
Mailing Address - Phone:386-283-1972
Mailing Address - Fax:
Practice Address - Street 1:23 BUFFALO GROVE PL
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-9462
Practice Address - Country:US
Practice Address - Phone:386-283-1972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program