Provider Demographics
NPI:1871861732
Name:PIECZONKA, CHRISTINE J (RN)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:J
Last Name:PIECZONKA
Suffix:
Gender:F
Credentials:RN
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Other - Credentials:
Mailing Address - Street 1:4737 LAKE SHORE RD
Mailing Address - Street 2:C/O ST MARY OF THE LAKE SCHOOL,
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-3308
Mailing Address - Country:US
Mailing Address - Phone:716-627-7700
Mailing Address - Fax:716-627-1255
Practice Address - Street 1:4737 LAKE SHORE RD
Practice Address - Street 2:C/O ST MARY OF THE LAKE SCHOOL,
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-3308
Practice Address - Country:US
Practice Address - Phone:716-627-7700
Practice Address - Fax:716-627-1255
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY425640251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)