Provider Demographics
NPI:1679134563
Name:WISNIEWSKI, ELZBIETA EDYTA (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:ELZBIETA
Middle Name:EDYTA
Last Name:WISNIEWSKI
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45522 HIDDEN VIEW CT
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:MI
Mailing Address - Zip Code:48315-5921
Mailing Address - Country:US
Mailing Address - Phone:248-550-9159
Mailing Address - Fax:
Practice Address - Street 1:45522 HIDDEN VIEW CT
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:MI
Practice Address - Zip Code:48315-5921
Practice Address - Country:US
Practice Address - Phone:248-550-9159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-22
Last Update Date:2019-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704285494363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care