Healthcare Provider Details

I. General information

NPI: 1003547928
Provider Name (Legal Business Name): CAROLYN MARIE PIERCE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2022
Last Update Date: 06/21/2022
Certification Date: 05/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 WOODLAND RD STE 304
SAINT HELENA CA
94574-9562
US

IV. Provider business mailing address

6 WOODLAND RD STE 304
SAINT HELENA CA
94574-9562
US

V. Phone/Fax

Practice location:
  • Phone: 707-963-7200
  • Fax: 707-963-7203
Mailing address:
  • Phone: 707-963-7200
  • Fax: 707-963-7203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95021354
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: