Healthcare Provider Details

I. General information

NPI: 1003729575
Provider Name (Legal Business Name): ALLENCIA WISNIEWSKI CPST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 N BOARDWALK
REHOBOTH BEACH DE
19971-2162
US

IV. Provider business mailing address

511 N BOARDWALK
REHOBOTH BEACH DE
19971-2162
US

V. Phone/Fax

Practice location:
  • Phone: 302-258-6497
  • Fax:
Mailing address:
  • Phone: 302-258-6497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number1705352
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: