Provider Demographics
NPI:1457423873
Name:PISARSKI, DAWN M (ANP)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:M
Last Name:PISARSKI
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 DAVISON CT
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-5370
Mailing Address - Country:US
Mailing Address - Phone:716-433-8640
Mailing Address - Fax:716-433-4897
Practice Address - Street 1:64 DAVISON CT
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-5370
Practice Address - Country:US
Practice Address - Phone:716-433-8640
Practice Address - Fax:716-433-4897
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY409074-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02684068Medicaid
NY02684068Medicaid
NYQ47769Medicare UPIN