1699139469 NPI number — LAURA ELAINE BRYANT-PIATKOWSKI D.O.

Table of content: LAURA ELAINE BRYANT-PIATKOWSKI D.O. (NPI 1699139469)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699139469 NPI number — LAURA ELAINE BRYANT-PIATKOWSKI D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRYANT-PIATKOWSKI
Provider First Name:
LAURA
Provider Middle Name:
ELAINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BRYANT
Provider Other First Name:
LAURA
Provider Other Middle Name:
ELAINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1699139469
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5523 N SHORELAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITEFISH BAY
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53217-5158
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10945 N PORT WASHINGTON RD STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEQUON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53092-5078
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-292-3151
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/07/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 69165 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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