Provider Demographics
NPI:1265843916
Name:WISNESKI, NATALIE R (PA-C)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:R
Last Name:WISNESKI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:
Other - Last Name:SCHAEFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1336 BRISTOL PIKE
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-5660
Mailing Address - Country:US
Mailing Address - Phone:215-638-3444
Mailing Address - Fax:215-638-3449
Practice Address - Street 1:1336 BRISTOL PIKE STE 103
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-5660
Practice Address - Country:US
Practice Address - Phone:215-638-3444
Practice Address - Fax:215-638-3449
Is Sole Proprietor?:No
Enumeration Date:2014-05-15
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00331600363AM0700X
PAOA003288363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical