Provider Demographics
NPI:1235836115
Name:WISNIEWSKI, MELISSA MAE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:MAE
Last Name:WISNIEWSKI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1 SCHOOL ST STE 107
Mailing Address - Street 2:
Mailing Address - City:GOWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14070-1143
Mailing Address - Country:US
Mailing Address - Phone:716-241-7067
Mailing Address - Fax:833-464-5024
Practice Address - Street 1:1 SCHOOL ST STE 107
Practice Address - Street 2:
Practice Address - City:GOWANDA
Practice Address - State:NY
Practice Address - Zip Code:14070-1143
Practice Address - Country:US
Practice Address - Phone:716-241-7067
Practice Address - Fax:833-464-5024
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF351176-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily