Healthcare Provider Details

I. General information

NPI: 1376122572
Provider Name (Legal Business Name): NICOLE CIESLAK FNTP, CPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 04/05/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6901 E CHAUNCEY LN APT 2183
PHOENIX AZ
85054-5130
US

IV. Provider business mailing address

6901 E CHAUNCEY LN APT 2183
PHOENIX AZ
85054-5130
US

V. Phone/Fax

Practice location:
  • Phone: 412-287-3259
  • Fax:
Mailing address:
  • Phone: 412-287-3259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: