Provider Demographics
NPI:1891311239
Name:DZIEKAN, MARIA JANINE (PA-C)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:JANINE
Last Name:DZIEKAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5949 CAMPBELL BLVD
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-9204
Mailing Address - Country:US
Mailing Address - Phone:716-544-6730
Mailing Address - Fax:
Practice Address - Street 1:5949 CAMPBELL BLVD
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-9204
Practice Address - Country:US
Practice Address - Phone:716-778-8627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant