Healthcare Provider Details

I. General information

NPI: 1285505420
Provider Name (Legal Business Name): DANIELLE WYSOKINSKI CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2025
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 E 2ND ST
BLOOMSBURG PA
17815-1869
US

IV. Provider business mailing address

308 E 2ND ST
BLOOMSBURG PA
17815-1869
US

V. Phone/Fax

Practice location:
  • Phone: 570-961-3361
  • Fax:
Mailing address:
  • Phone: 570-961-3361
  • Fax: 570-961-3364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN638478
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP033869
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: