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General NPI Number Information
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NPI Number | 1881112449
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Entity Type | Individual
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Provider Name | TESS WIANECKI PA
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Gender | Female
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Dates
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Enumeration Date | 09/05/2017
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Last Update Date | 09/25/2024
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Provider Practice Location Address
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Address Line | 860 OAK PARK BLVD STE 101
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City | ARROYO GRANDE
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State | CA
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Zip | 93420-1800
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Country | US
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Telephone | 805-202-8245
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Fax | 805-202-8117
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Provider Business Mailing Address
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Address Line | PO BOX 2505
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City | PISMO BEACH
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State | CA
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Zip | 93448-2505
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Country | US
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Telephone | 805-202-8245
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Fax | 805-202-8117
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 55021
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License Number State | CA
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