Provider Demographics
NPI:1205221041
Name:CIEZKI, BRIAN FRANCIS (ACNP)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:FRANCIS
Last Name:CIEZKI
Suffix:
Gender:M
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 5TH ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:WA
Mailing Address - Zip Code:99403-3001
Mailing Address - Country:US
Mailing Address - Phone:509-295-8398
Mailing Address - Fax:509-295-8416
Practice Address - Street 1:1625 5TH ST
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:WA
Practice Address - Zip Code:99403
Practice Address - Country:US
Practice Address - Phone:509-295-8398
Practice Address - Fax:509-295-8416
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-30
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID53676363LA2200X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health