Provider Demographics
NPI:1891565016
Name:CIESZKOWSKI, JODI LYN (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:LYN
Last Name:CIESZKOWSKI
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18 SONNY DR
Mailing Address - Street 2:
Mailing Address - City:OLD FORGE
Mailing Address - State:PA
Mailing Address - Zip Code:18518-1137
Mailing Address - Country:US
Mailing Address - Phone:570-468-5406
Mailing Address - Fax:570-209-7715
Practice Address - Street 1:409 N MAIN AVE STE 1
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18504-1798
Practice Address - Country:US
Practice Address - Phone:570-209-7878
Practice Address - Fax:570-209-7715
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS012156207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine