Individual provider Active NPI

Nicole M Cieslak, CST/CFA

  • Surgical Technologist
  • Charlotte, NC
National Provider Identifier
1053636019
Registry record updated May 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical TechnologistTaxonomy code 246ZS0410X
License
124768 Issued in NC
Practice address
2001 Vail Ave
Charlotte, NC 28207-1219
Phone
(704) 323-2248
NPI assigned
Apr 2, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 13, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Technologist 246ZS0410X 108145 FL
Surgical Technologist 246ZS0410X 124768 NC Primary

Addresses

Primary practice location

2001 Vail Ave
Charlotte, NC 28207-1219

Mailing address

4601 Park Rd
Suite 300
Charlotte, NC 28209-3239
Phone (704) 323-2000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
108145FLMDSurgical Technologist
124768NCMDSurgical Technologist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1270166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1305244800000",
    "number": "1053636019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4601 PARK RD",
            "address_2": "SUITE 300",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282093239",
            "telephone_number": "704-323-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 VAIL AVE",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282071219",
            "telephone_number": "704-323-2248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CIESLAK",
        "first_name": "NICOLE",
        "middle_name": "M",
        "credential": "CST/CFA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-04-02",
        "last_updated": "2011-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246ZS0410X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Technologist",
            "state": "FL",
            "license": "108145",
            "primary": false
        },
        {
            "code": "246ZS0410X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Technologist",
            "state": "NC",
            "license": "124768",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.