Provider Demographics
NPI:1619757648
Name:WISNIESKI, MICHELE LYNN (RN)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:LYNN
Last Name:WISNIESKI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:WISNIESKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:7 WILDWOOD GDNS APT B1
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-2315
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7 WILDWOOD GDNS APT B1
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-2315
Practice Address - Country:US
Practice Address - Phone:516-492-1543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY618862-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse