1760585335 NPI number — QUYNH VU WISNIEWSKI MD

Table of content: QUYNH VU WISNIEWSKI MD (NPI 1760585335)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760585335 NPI number — QUYNH VU WISNIEWSKI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WISNIEWSKI
Provider First Name:
QUYNH
Provider Middle Name:
VU
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VU
Provider Other First Name:
QUYNH
Provider Other Middle Name:
BICH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1760585335
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/27/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7557 DANNAHER DR STE 130
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POWELL
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37849-1509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-512-1180
Provider Business Mailing Address Fax Number:
865-512-1185

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7557 A DANNAHER DR
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
POWELL
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37849
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-689-1122
Provider Business Practice Location Address Fax Number:
866-340-3781
Provider Enumeration Date:
09/07/2006

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: 208000000X , with the licence number:  29093 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3497395 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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