Provider Demographics
NPI:1376874024
Name:WISNIEWSKI, JESSICA ANN (MSN CPNP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ANN
Last Name:WISNIEWSKI
Suffix:
Gender:F
Credentials:MSN CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 MICHIGAN AVENUE N.W.
Mailing Address - Street 2:4TH FLOOR EAST
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010
Mailing Address - Country:US
Mailing Address - Phone:202-476-4585
Mailing Address - Fax:202-476-3091
Practice Address - Street 1:111 MICHIGAN AVENUE N.W.
Practice Address - Street 2:4TH FLOOR EAST
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010
Practice Address - Country:US
Practice Address - Phone:202-476-4585
Practice Address - Fax:202-476-3091
Is Sole Proprietor?:No
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1012789363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics