| NPI | 1407110810 |
|---|---|
| Other Name | STACEY ANNE WISNIEWSKI |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA TP006187B) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA TP006187B) |
| Enumeration Date | 2012-06-29 |
| Last Update Date | 2018-01-18 |