Provider Demographics
NPI:1952696809
Name:PIECHOCKI, BRYAN EDWARD (RN)
Entity type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:EDWARD
Last Name:PIECHOCKI
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 BROOKVIEW PL
Mailing Address - Street 2:
Mailing Address - City:COMBINED LOCKS
Mailing Address - State:WI
Mailing Address - Zip Code:54113-1200
Mailing Address - Country:US
Mailing Address - Phone:920-585-5256
Mailing Address - Fax:
Practice Address - Street 1:104 BROOKVIEW PL
Practice Address - Street 2:
Practice Address - City:COMBINED LOCKS
Practice Address - State:WI
Practice Address - Zip Code:54113-1200
Practice Address - Country:US
Practice Address - Phone:920-585-5256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI177451-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse