Provider Demographics
NPI:1639508724
Name:PIECHOWSKI, SUSAN MELISSA (APNP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MELISSA
Last Name:PIECHOWSKI
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:MELISSA
Other - Last Name:FORTISI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:N1798 COUNTY ROAD Z
Mailing Address - Street 2:
Mailing Address - City:WAUTOMA
Mailing Address - State:WI
Mailing Address - Zip Code:54982-7300
Mailing Address - Country:US
Mailing Address - Phone:920-622-5560
Mailing Address - Fax:920-622-6021
Practice Address - Street 1:701 GROVE AVE
Practice Address - Street 2:
Practice Address - City:WILD ROSE
Practice Address - State:WI
Practice Address - Zip Code:54984-6901
Practice Address - Country:US
Practice Address - Phone:920-622-5560
Practice Address - Fax:920-622-6021
Is Sole Proprietor?:No
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5514-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily