Healthcare Provider Details

I. General information

NPI: 1003096934
Provider Name (Legal Business Name): JOANNA BETH WISOTSKY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JOANNA BETH BERNSTEIN PA

II. Dates (important events)

Enumeration Date: 11/08/2007
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NEW WAVERLY PL STE 203
CARY NC
27518-7404
US

IV. Provider business mailing address

600 NEW WAVERLY PL STE 203
CARY NC
27518-7404
US

V. Phone/Fax

Practice location:
  • Phone: 919-410-7083
  • Fax: 919-436-2144
Mailing address:
  • Phone: 919-410-7083
  • Fax: 919-436-2144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number001000939
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: