Healthcare Provider Details

I. General information

NPI: 1760482723
Provider Name (Legal Business Name): JANET S PIECK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 03/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 E 23RD ST
FREMONT NE
68025-2303
US

IV. Provider business mailing address

PO BOX 485
BOYS TOWN NE
68010-0485
US

V. Phone/Fax

Practice location:
  • Phone: 402-727-3586
  • Fax: 402-727-3618
Mailing address:
  • Phone: 402-727-3580
  • Fax: 402-727-3618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number16518
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: