Provider Demographics
NPI:1467270421
Name:WISZ, STEVIE LYNNE (PA-C)
Entity type:Individual
Prefix:
First Name:STEVIE
Middle Name:LYNNE
Last Name:WISZ
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:884 VIVA CT
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-2465
Mailing Address - Country:US
Mailing Address - Phone:805-598-3348
Mailing Address - Fax:
Practice Address - Street 1:4060 FOURTH AVE STE 650
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2121
Practice Address - Country:US
Practice Address - Phone:805-598-3348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-30
Last Update Date:2024-11-27
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant