Provider Demographics
NPI:1669458139
Name:PIASCYK, BONNIE M (APRN)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:M
Last Name:PIASCYK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 MASONIC AVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-3095
Mailing Address - Country:US
Mailing Address - Phone:203-265-5720
Mailing Address - Fax:203-679-5623
Practice Address - Street 1:67 MASONIC AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-3095
Practice Address - Country:US
Practice Address - Phone:203-265-5720
Practice Address - Fax:203-679-5623
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000805364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004204210Medicaid
CT004204210Medicaid
CT500000388Medicare PIN