Provider Demographics
NPI:1750105367
Name:WALTERS PIEKARSKI, NICHOLE J (MSN)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:J
Last Name:WALTERS PIEKARSKI
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:NICHOLE
Other - Middle Name:J
Other - Last Name:PIEKARSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3815 N SCHREIBER WAY UNIT 102
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-8434
Mailing Address - Country:US
Mailing Address - Phone:208-667-4557
Mailing Address - Fax:208-765-2887
Practice Address - Street 1:3815 N SCHREIBER WAY UNIT 102
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-8434
Practice Address - Country:US
Practice Address - Phone:208-667-4557
Practice Address - Fax:208-765-2887
Is Sole Proprietor?:No
Enumeration Date:2024-11-11
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID34817363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care