Provider Demographics
NPI:1588442255
Name:KRAWIECKI, LISA (CERTIFIED NURSE ASST)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:KRAWIECKI
Suffix:
Gender:F
Credentials:CERTIFIED NURSE ASST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 BROADSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-5736
Mailing Address - Country:US
Mailing Address - Phone:718-358-9841
Mailing Address - Fax:
Practice Address - Street 1:1000 BROADSTONE WAY
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-5736
Practice Address - Country:US
Practice Address - Phone:718-358-9841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-15
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC562135376K00000X
CTNA91278956376K00000X
NYNYNC0463844R376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide