Healthcare Provider Details

I. General information

NPI: 1306683321
Provider Name (Legal Business Name): HAYLEY MARIE WISHNER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2024
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6620 COYLE AVE STE 303
CARMICHAEL CA
95608-6337
US

IV. Provider business mailing address

6874 ALCEDO CT
CHINO CA
91710-6298
US

V. Phone/Fax

Practice location:
  • Phone: 916-965-4000
  • Fax:
Mailing address:
  • Phone: 909-573-7279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: