Provider Demographics
NPI:1316093362
Name:KUSNIERCZYK, PETER (FNP MSN)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:KUSNIERCZYK
Suffix:
Gender:M
Credentials:FNP MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 MIRAMAR AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-1213
Mailing Address - Country:US
Mailing Address - Phone:415-585-4509
Mailing Address - Fax:510-494-7210
Practice Address - Street 1:6066 CIVIC TERRACE AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560-3746
Practice Address - Country:US
Practice Address - Phone:510-494-7235
Practice Address - Fax:510-494-7210
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA391426363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily