=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720359847
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAWN PIASCIK L.L.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/20/2012
-----------------------------------------------------
Last Update Date | 07/10/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 68364 S MAIN ST
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48062-1925
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-430-4075
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 68364 S MAIN ST
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48062-1218
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-430-4075
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/EDUCATOR
-----------------------------------------------------
Name | MS. DAWN LEE PIASCIK
-----------------------------------------------------
Credential | R.N.B.S.N.,CHT.
-----------------------------------------------------
Telephone | 586-430-4075
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WM0102X
-----------------------------------------------------
Taxonomy Name | Maternal Newborn Registered Nurse
-----------------------------------------------------
License Number | 4704175112
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 174H00000X
-----------------------------------------------------
Taxonomy Name | Health Educator
-----------------------------------------------------
License Number | 4704175112
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------