Healthcare Provider Details

I. General information

NPI: 1720292915
Provider Name (Legal Business Name): RAYMOND ANTHONY PIENCZYKOWSKI JR. PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 09/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 NW 167TH PL 6
BEAVERTON OR
97006-4908
US

IV. Provider business mailing address

1975 NW 167TH PL 6
BEAVERTON OR
97006-4908
US

V. Phone/Fax

Practice location:
  • Phone: 503-389-0280
  • Fax: 503-352-7894
Mailing address:
  • Phone: 503-389-0280
  • Fax: 503-352-7894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number200650130NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: