Provider Demographics
NPI:1558413054
Name:PIECZYNSKI, KIMBERLY (NP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:PIECZYNSKI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 FOXFIELD RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-5799
Mailing Address - Country:US
Mailing Address - Phone:630-797-4255
Mailing Address - Fax:630-797-4259
Practice Address - Street 1:2900 FOXFIELD RD
Practice Address - Street 2:SUITE 203
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-5799
Practice Address - Country:US
Practice Address - Phone:630-797-4255
Practice Address - Fax:630-797-4259
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209 003073363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1033149844OtherCDPG NPI
IL0222075OtherCDPG BCBS
920540OtherMEDICARE PTAN (GROUP)
920540008OtherMEDICARE PTAN (INDIVIDUAL)
920540008OtherMEDICARE PTAN (INDIVIDUAL)
IL1033149844OtherCDPG NPI