NPIMap

Individual provider Active NPI

Nicole M Wisniewski, PA-C

  • Medical Physician Assistant
  • Manistee, MI
National Provider Identifier
1992960033
Registry record updated Oct 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
5601005972 Issued in MI
Practice address
1465 E Parkdale Ave
Manistee, MI 49660-9709
Phone
(231) 398-1000
Fax
(989) 340-1214
NPI assigned
Jul 28, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 5601005972 MI Primary

Addresses

Primary practice location

1465 E Parkdale Ave
Manistee, MI 49660-9709

Mailing address

10850 E Traverse Hwy
Suite 4400
Traverse City, MI 49684-1364
Phone (231) 346-6800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110527000339 MI Practitioner - Physician Assistant 9537221767 Reassigns benefits to 7 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pic Indiana PCGroup PAC ID 3476790239, 143 clinicians

Practice addresses (Care Compare)

1131 M 32
Alpena, MI 49707-8222
Phone (989) 250-1925

Hospital & facility affiliations

  • Mymichigan Medical Center Alpena Hospital, Alpena, MI, CCN 230036

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Hospitalist Medicine Physicians of Michigan, PLLC CurrentSince Jul 16, 2019 Accepting new patients
Mymichigan Medical Center Clare CurrentSince Mar 21, 2023 Accepting new patients
Mymichigan Medical Center Clare CurrentSince Mar 21, 2023 Accepting new patients
Mymichigan Medical Center Alpena CurrentSince Jun 1, 2019 Accepting new patients
West Branch Regional Medical Center Current Accepting new patients
Mymichigan Medical Center West Branch CurrentSince Oct 1, 2023 Accepting new patients
Hometown Urgent Care of Michigan, P.C. Past Accepting new patients
Madison Medical and Sports Rehabilitation L.L.C Past Accepting new patients

Locations

818 Riverside Ave
Adrian, MI 49221
Phone (517) 263-0711

300 E Warwick Dr
Alma, MI 48801
Phone (989) 463-0104

1501 W Chisholm St
Alpena, MI 49707
Phone (989) 356-7000

11899 M 32
Atlanta, MI 49709
Phone (989) 785-4855

703 N McEwan St
Clare, MI 48617
Phone (989) 802-5000

177 N Barlow Rd
Harrisville, MI 48740
Phone (989) 736-3020

1721 S Stephenson Ave
Iron Mountain, MI 49801
Phone (906) 776-5415

1 Atkinson Dr
Ludington, MI 49431
Phone (231) 843-2591

1465 E Parkdale Ave
Manistee, MI 49660
Phone (231) 398-1000

4000 Wellness Dr
Midland, MI 48670
Phone (844) 832-1956

2463 S M 30
West Branch, MI 48661
Phone (517) 345-3660

Organizations & group practices 12

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1217203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1477612800000",
    "number": "1992960033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10850 E TRAVERSE HWY",
            "address_2": "SUITE 4400",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496841364",
            "telephone_number": "231-346-6800",
            "fax_number": "989-340-1214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1465 E PARKDALE AVE",
            "city": "MANISTEE",
            "state": "MI",
            "postal_code": "496609709",
            "telephone_number": "231-398-1000",
            "fax_number": "989-340-1214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISNIEWSKI",
        "first_name": "NICOLE",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-28",
        "last_updated": "2016-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MI",
            "license": "5601005972",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manistee, MI

Sources for this page

Verify at the official NPI Registry.