Provider Demographics
NPI:1699342568
Name:WISNIEWSKI, ANNALISE EVELYN (MED)
Entity type:Individual
Prefix:
First Name:ANNALISE
Middle Name:EVELYN
Last Name:WISNIEWSKI
Suffix:
Gender:
Credentials:MED
Other - Prefix:
Other - First Name:ANNALISE
Other - Middle Name:EVELYN
Other - Last Name:FARINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:45-419 MOKULELE DR APT 1
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-2110
Mailing Address - Country:US
Mailing Address - Phone:815-355-5169
Mailing Address - Fax:
Practice Address - Street 1:302 CALIFORNIA AVE STE 212
Practice Address - Street 2:
Practice Address - City:WAHIAWA
Practice Address - State:HI
Practice Address - Zip Code:96786-1841
Practice Address - Country:US
Practice Address - Phone:808-542-9599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-08
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMHC-1096101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional