1346220399 NPI number — MRS. KIRSTEN ANN WISNIAKOWSKI D.D.S

Table of content: MRS. KIRSTEN ANN WISNIAKOWSKI D.D.S (NPI 1346220399)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346220399 NPI number — MRS. KIRSTEN ANN WISNIAKOWSKI D.D.S

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WISNIAKOWSKI
Provider First Name:
KIRSTEN
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KOCH
Provider Other First Name:
KIRSTEN
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.D.S
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1346220399
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/13/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
760 EAST AVE
Provider Second Line Business Mailing Address:
BLDG 3911
Provider Business Mailing Address City Name:
PENSACOLA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32508-5136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-452-8970
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
760 EAST AVE
Provider Second Line Business Practice Location Address:
BLDG 3911
Provider Business Practice Location Address City Name:
PENSACOLA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32508-5136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-452-8970
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/18/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  52413 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)