Healthcare Provider Details

I. General information

NPI: 1275785768
Provider Name (Legal Business Name): HILARY MIACZYNSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2008
Last Update Date: 05/24/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 CHARLOIS BLVD STE 100 SUITE 100
WINSTON SALEM NC
27103-1549
US

IV. Provider business mailing address

PO BOX 60447 SUITE 5770
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 336-718-7470
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number426
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: