Healthcare Provider Details

I. General information

NPI: 1760585335
Provider Name (Legal Business Name): QUYNH VU WISNIEWSKI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: QUYNH BICH VU

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 08/27/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7557 A DANNAHER DR SUITE 130
POWELL TN
37849
US

IV. Provider business mailing address

7557 DANNAHER DR STE 130
POWELL TN
37849-1509
US

V. Phone/Fax

Practice location:
  • Phone: 865-689-1122
  • Fax: 866-340-3781
Mailing address:
  • Phone: 865-512-1180
  • Fax: 865-512-1185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number29093
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: