Healthcare Provider Details

I. General information

NPI: 1356033203
Provider Name (Legal Business Name): ANNA AGNIESZKA PIASECZNA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA AGNIESZKA PIASECZNA FNP

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S BUENA VISTA ST STE 420
BURBANK CA
91505-4571
US

IV. Provider business mailing address

2603 MADISON AVE
ALTADENA CA
91001-2325
US

V. Phone/Fax

Practice location:
  • Phone: 818-238-2350
  • Fax:
Mailing address:
  • Phone: 818-703-3122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95025338
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WS0121X
TaxonomyPlastic Surgery Registered Nurse
License Number95210440
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: