Provider Demographics
NPI:1013612209
Name:PIELA, JADICA LOUISE
Entity Type:Individual
Prefix:
First Name:JADICA
Middle Name:LOUISE
Last Name:PIELA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 BELMONT RD
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-3911
Mailing Address - Country:US
Mailing Address - Phone:918-360-3569
Mailing Address - Fax:
Practice Address - Street 1:520 BELMONT RD
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-3911
Practice Address - Country:US
Practice Address - Phone:918-360-3569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program