Provider Demographics
NPI:1356415889
Name:WOLNIAK, LISA L (PA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:L
Last Name:WOLNIAK
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:251 SALINA MEADOWS PARKWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-4516
Mailing Address - Country:US
Mailing Address - Phone:315-464-2000
Mailing Address - Fax:315-464-2010
Practice Address - Street 1:750 EAST ADAMS STREET
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210
Practice Address - Country:US
Practice Address - Phone:315-464-9335
Practice Address - Fax:315-464-9338
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2022-05-26
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Provider Licenses
StateLicense IDTaxonomies
NY006670-1363A00000X
NY006670363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant