Provider Demographics
NPI:1447898150
Name:WISOWATY, NICOLE J (PA-C)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:J
Last Name:WISOWATY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:J
Other - Last Name:SCHNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4110 INDEPENDENCE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:SCHNECKSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18078-2584
Mailing Address - Country:US
Mailing Address - Phone:610-769-4200
Mailing Address - Fax:
Practice Address - Street 1:4110 INDEPENDENCE DR STE 300
Practice Address - Street 2:
Practice Address - City:SCHNECKSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18078-2584
Practice Address - Country:US
Practice Address - Phone:610-769-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-12
Last Update Date:2024-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA061812363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant