Provider Demographics
NPI:1851984355
Name:WIESCHOLEK, SHERYL (RN)
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:
Last Name:WIESCHOLEK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4346 OPARK ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-9490
Mailing Address - Country:US
Mailing Address - Phone:269-804-9788
Mailing Address - Fax:
Practice Address - Street 1:918 JASPER ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001-2853
Practice Address - Country:US
Practice Address - Phone:269-382-0515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-16
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704240177163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult