Provider Demographics
NPI:1437605367
Name:WISNIEWSKI, KIMBERLY
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
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 1:5253 SUNCREEK COURT
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48094
Mailing Address - Country:US
Mailing Address - Phone:586-665-4841
Mailing Address - Fax:
Practice Address - Street 1:5253 SUNCREEK COURT
Practice Address - Street 2:
Practice Address - City:WASHINGTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48094
Practice Address - Country:US
Practice Address - Phone:586-665-4841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other