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General NPI Number Information
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NPI Number | 1477534279
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Entity Type | Individual
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Provider Name | EDMUND J PIASECKI III FNP
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Gender | Male
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Dates
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Enumeration Date | 11/08/2005
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Last Update Date | 01/30/2012
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Provider Practice Location Address
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Address Line | 1111 6TH AVE MERCY MEDICAL CENTE ER
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City | DES MOINES
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State | IA
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Zip | 50314-2610
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Country | US
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Telephone | 515-247-3173
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Fax |
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Provider Business Mailing Address
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Address Line | 2207 WILLOWMERE DR
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City | DES MOINES
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State | IA
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Zip | 50321-1539
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Country | US
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Telephone | 515-244-4550
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | A100182
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2001021075
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 45213
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License Number State | KS
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