Healthcare Provider Details

I. General information

NPI: 1679546691
Provider Name (Legal Business Name): ROXANNE I. PIECEK CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MADIGAN ARMY MEDICAL CENTER DEPARTMENT OF OB/GYN
TACOMA WA
98431-0001
US

IV. Provider business mailing address

5804 OLIVE AVE SE
AUBURN WA
98092-8001
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-1416
  • Fax:
Mailing address:
  • Phone: 253-939-2625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAP30006647
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: