Healthcare Provider Details

I. General information

NPI: 1417731902
Provider Name (Legal Business Name): CARLI WISHNESKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2023
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 MCDANIEL DR STE 50
WEST CHESTER PA
19380-7030
US

IV. Provider business mailing address

760 VALLEY RD
PHOENIXVILLE PA
19460-3641
US

V. Phone/Fax

Practice location:
  • Phone: 484-905-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP028102
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: