Basic Information
| Provider Information | |||||||||
| NPI: | 1326371261 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BIELAWSKI | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | PAUL | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | VETERANS ADMINISTRATION | ||||||||
| Address2: | 555 WILLARD AVENUE | ||||||||
| City: | NEWINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061112631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8668087921 | ||||||||
| FaxNumber: | 8606676875 | ||||||||
| Practice Location | |||||||||
| Address1: | VETERANS ADMINISTRATION | ||||||||
| Address2: | 555 WILLARD AVENUE | ||||||||
| City: | NEWINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8668087921 | ||||||||
| FaxNumber: | 8606676875 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2009 | ||||||||
| LastUpdateDate: | 08/01/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP2300X | 5536 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
No ID Information.