Healthcare Provider Details

I. General information

NPI: 1205221041
Provider Name (Legal Business Name): BRIAN FRANCIS CIEZKI ACNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 02/07/2020
Certification Date: 02/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 5TH ST
CLARKSTON WA
99403
US

IV. Provider business mailing address

1625 5TH ST
CLARKSTON WA
99403-3001
US

V. Phone/Fax

Practice location:
  • Phone: 509-295-8398
  • Fax: 509-295-8416
Mailing address:
  • Phone: 509-295-8398
  • Fax: 509-295-8416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number53676
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: