Provider Demographics
NPI:1225405525
Name:ZYNIEWICZ, PETER (RN)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:ZYNIEWICZ
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5309 PONTIAC ST
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-3513
Mailing Address - Country:US
Mailing Address - Phone:206-799-0344
Mailing Address - Fax:
Practice Address - Street 1:5309 PONTIAC ST
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3513
Practice Address - Country:US
Practice Address - Phone:206-799-0344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-21
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60302767163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse