Provider Demographics
NPI:1619906880
Name:PIEKARSKI, IRENE MARY (MD)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:MARY
Last Name:PIEKARSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 NE 150TH ST
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-7221
Mailing Address - Country:US
Mailing Address - Phone:206-363-5353
Mailing Address - Fax:206-363-7335
Practice Address - Street 1:1507 NE 150TH ST
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-7221
Practice Address - Country:US
Practice Address - Phone:206-363-5353
Practice Address - Fax:206-363-7335
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00025863208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1093137Medicaid
WA1093137Medicaid