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General NPI Number Information
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NPI Number | 1689062390
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Entity Type | Individual
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Provider Name | JACKIE ANN WISZCZUR FNP
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Gender | Female
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Dates
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Enumeration Date | 01/03/2015
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 12305 MCCORD RD
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-7299
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Country | US
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Telephone | 910-553-8494
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Fax | 931-202-8226
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Provider Business Mailing Address
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Address Line | 12305 MCCORD RD
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-7299
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Country | US
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Telephone | 910-553-8494
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Fax | 931-202-8226
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | SP014113
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5020267
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License Number State | NC
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