Basic Information
| Provider Information | |||||||||
| NPI: | 1326474115 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIERZKOWSKI | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | V | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | RT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 822 HILLTOP DR | ||||||||
| Address2: | |||||||||
| City: | CLARKS SUMMIT | ||||||||
| State: | PA | ||||||||
| PostalCode: | 184112702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5705873363 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1111 E END BLVD | ||||||||
| Address2: | |||||||||
| City: | WILKES BARRE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 187110030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5708243521 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2013 | ||||||||
| LastUpdateDate: | 09/24/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2471C3401X | 265163 | MN | Y | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Computed Tomography |
No ID Information.