Provider Demographics
NPI:1912338450
Name:PICCOLO, LIESL FLORA (RN LM CPM PHN FNP-C)
Entity Type:Individual
Prefix:
First Name:LIESL
Middle Name:FLORA
Last Name:PICCOLO
Suffix:
Gender:F
Credentials:RN LM CPM PHN FNP-C
Other - Prefix:
Other - First Name:LIESL
Other - Middle Name:
Other - Last Name:WEIMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LM CPM
Mailing Address - Street 1:530 41ST ST APT 12
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-2440
Mailing Address - Country:US
Mailing Address - Phone:510-277-2627
Mailing Address - Fax:
Practice Address - Street 1:837 ADDISON ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94710-2047
Practice Address - Country:US
Practice Address - Phone:510-941-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-10
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM 345176B00000X
CA95022010363LF0000X
CARN95229608163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No176B00000XOther Service ProvidersMidwife
No163W00000XNursing Service ProvidersRegistered Nurse