Provider Demographics
NPI:1477668069
Name:BIENKOWSKI, ANNA (MD)
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:
Last Name:BIENKOWSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:ANNA
Other - Middle Name:URSULA
Other - Last Name:GODZINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:825 JADWIN AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3589
Mailing Address - Country:US
Mailing Address - Phone:509-946-1020
Mailing Address - Fax:509-946-0827
Practice Address - Street 1:825 JADWIN AVE STE 250
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3589
Practice Address - Country:US
Practice Address - Phone:509-946-1020
Practice Address - Fax:509-946-0827
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036094248207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036094248Medicaid
IL207190Medicare ID - Type Unspecified