Provider Demographics
NPI:1477534279
Name:PIASECKI III, EDMUND J (FNP)
Entity Type:Individual
Prefix:MR
First Name:EDMUND
Middle Name:J
Last Name:PIASECKI III
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:MR
Other - First Name:ED
Other - Middle Name:
Other - Last Name:PIASECKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:2207 WILLOWMERE DR
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50321-1539
Mailing Address - Country:US
Mailing Address - Phone:515-244-4550
Mailing Address - Fax:
Practice Address - Street 1:1111 6TH AVE
Practice Address - Street 2:MERCY MEDICAL CENTE ER
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-2610
Practice Address - Country:US
Practice Address - Phone:515-247-3173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA100182363LF0000X
MO2001021075363LF0000X
KS45213363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO425701513Medicaid
IA0463448Medicaid
MO425701505Medicaid
IA719260370Medicare PIN
IA0463448Medicaid