Provider Demographics
NPI:1730876202
Name:WYSZOMIRSKI, JOANNA MONIKA
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:MONIKA
Last Name:WYSZOMIRSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 MCGEE LN
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06037-2070
Mailing Address - Country:US
Mailing Address - Phone:959-208-5662
Mailing Address - Fax:
Practice Address - Street 1:38 MCGEE LN
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:CT
Practice Address - Zip Code:06037-2070
Practice Address - Country:US
Practice Address - Phone:959-208-5662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT010240163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse