Healthcare Provider Details

I. General information

NPI: 1790249993
Provider Name (Legal Business Name): HANNAH PIENCIAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2019
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2877 E FOUNTAIN BLVD
COLORADO SPRINGS CO
80910-2312
US

IV. Provider business mailing address

PO BOX 746081
ATLANTA GA
30374-6081
US

V. Phone/Fax

Practice location:
  • Phone: 719-454-6009
  • Fax:
Mailing address:
  • Phone: 312-733-9730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ00822400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1661157
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: