Healthcare Provider Details

I. General information

NPI: 1760461040
Provider Name (Legal Business Name): MARK A WOZNIAK P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 08/14/2022
Certification Date: 08/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4704 BAYBERRY ST
SCHOFIELD WI
54476-6097
US

IV. Provider business mailing address

4704 BAYBERRY ST
SCHOFIELD WI
54476-6097
US

V. Phone/Fax

Practice location:
  • Phone: 715-843-0366
  • Fax:
Mailing address:
  • Phone: 715-843-0366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number872-023
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: