Provider Demographics
NPI:1669043303
Name:WISNIEWSKI, CHALYNNE MARIE (MAT, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:CHALYNNE
Middle Name:MARIE
Last Name:WISNIEWSKI
Suffix:
Gender:F
Credentials:MAT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1941
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82073-1941
Mailing Address - Country:US
Mailing Address - Phone:720-556-6540
Mailing Address - Fax:
Practice Address - Street 1:32 CAMPUS DRIVE UNIVERSITY OF MONTANA
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59812-1171
Practice Address - Country:US
Practice Address - Phone:406-243-6282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-04
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer