Provider Demographics
NPI:1134718877
Name:KLISIEWICZ, EUNIKA (AP,DOM)
Entity type:Individual
Prefix:
First Name:EUNIKA
Middle Name:
Last Name:KLISIEWICZ
Suffix:
Gender:F
Credentials:AP,DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9250 CORKSCREW RD STE 15
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-3217
Mailing Address - Country:US
Mailing Address - Phone:239-687-3199
Mailing Address - Fax:239-398-9437
Practice Address - Street 1:9250 CORKSCREW RD STE 15
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-3217
Practice Address - Country:US
Practice Address - Phone:239-687-3199
Practice Address - Fax:239-398-9437
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-17
Last Update Date:2021-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP4212171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist