Provider Demographics
NPI:1972995629
Name:PIETRUCZUK, MARGARET (APRN)
Entity type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:
Last Name:PIETRUCZUK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 EASTWOOD RD STE 200
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-1873
Mailing Address - Country:US
Mailing Address - Phone:910-319-7744
Mailing Address - Fax:910-319-7754
Practice Address - Street 1:432 EASTWOOD RD STE 200
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-1873
Practice Address - Country:US
Practice Address - Phone:910-319-7744
Practice Address - Fax:910-319-7754
Is Sole Proprietor?:No
Enumeration Date:2015-03-04
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209012551363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1972995629Medicaid