| NPI | 1265826275 |
|---|---|
| Former Name | KIMBERLY MARIE WISNIEWSKI |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 018586) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601007307) |
| Enumeration Date | 2015-03-27 |
| Last Update Date | 2019-09-03 |