Provider Demographics
NPI:1881052462
Name:KWIECIEN, DANIEL (PA-C)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:KWIECIEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 CENTRAL ST
Mailing Address - Street 2:UNIT C6
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-2748
Mailing Address - Country:US
Mailing Address - Phone:781-413-1504
Mailing Address - Fax:
Practice Address - Street 1:207 SOUTHBRIDGE ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MA
Practice Address - Zip Code:01501-2548
Practice Address - Country:US
Practice Address - Phone:508-832-7118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-10
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant