Healthcare Provider Details

I. General information

NPI: 1003362419
Provider Name (Legal Business Name): MARY WISHNESKY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2016
Last Update Date: 08/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9014 ANSONIA AVE
BROOKLYN OH
44144-2511
US

IV. Provider business mailing address

9014 ANSONIA AVE
BROOKLYN OH
44144-2511
US

V. Phone/Fax

Practice location:
  • Phone: 216-647-2122
  • Fax:
Mailing address:
  • Phone: 216-647-2122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: