Provider Demographics
NPI:1215670203
Name:WIERZBOWSKI, ISABELLA RENATA (PA-C)
Entity type:Individual
Prefix:
First Name:ISABELLA
Middle Name:RENATA
Last Name:WIERZBOWSKI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ISABELLA
Other - Middle Name:RENATA
Other - Last Name:GRIFASI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:8320 BELLONA AVE STE 20
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2097
Mailing Address - Country:US
Mailing Address - Phone:410-821-7546
Mailing Address - Fax:410-821-7576
Practice Address - Street 1:8320 BELLONA AVE STE 20
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2097
Practice Address - Country:US
Practice Address - Phone:410-821-7546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-18
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0008927363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty