Provider Demographics
NPI:1730291196
Name:PIELOCH, LISA JANE (CRNA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:JANE
Last Name:PIELOCH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PHYSICIANS ACCOUNTS RECEIVABLE
Mailing Address - Street 2:PO BOX 414628
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-4628
Mailing Address - Country:US
Mailing Address - Phone:781-449-6150
Mailing Address - Fax:
Practice Address - Street 1:2014 WASHINGTON ST
Practice Address - Street 2:NEWTON WELLESLEY HOSPITAL DEPT. OF ANESTHESIA
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462-1607
Practice Address - Country:US
Practice Address - Phone:671-243-6298
Practice Address - Fax:617-243-6184
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA142637367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANA0399Medicare ID - Type Unspecified