Provider Demographics
NPI:1982007894
Name:WISNIOSKI, HEIDI JILL (MA, RD, LD)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:JILL
Last Name:WISNIOSKI
Suffix:
Gender:F
Credentials:MA, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1290 RUNNING DEER DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:PA
Mailing Address - Zip Code:17922-9267
Mailing Address - Country:US
Mailing Address - Phone:239-314-6501
Mailing Address - Fax:
Practice Address - Street 1:1290 RUNNING DEER DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:PA
Practice Address - Zip Code:17922-9267
Practice Address - Country:US
Practice Address - Phone:239-314-6501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-06
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN006457133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered