Provider Demographics
NPI:1770239568
Name:PIETROWSKI, JENNIFER RAE (CST)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RAE
Last Name:PIETROWSKI
Suffix:
Gender:F
Credentials:CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22372 N 180TH DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85387-1562
Mailing Address - Country:US
Mailing Address - Phone:520-419-9148
Mailing Address - Fax:
Practice Address - Street 1:10230 W HAPPY VALLEY PKWY STE 200
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-4255
Practice Address - Country:US
Practice Address - Phone:623-683-7189
Practice Address - Fax:623-265-6349
Is Sole Proprietor?:No
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ192616246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist