Healthcare Provider Details

I. General information

NPI: 1033451901
Provider Name (Legal Business Name): JENNIFER LINDA PIERCE R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2013
Last Update Date: 03/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 COUNTY ROUTE 35
CANTON NY
13617-3937
US

IV. Provider business mailing address

1255 COUNTY ROUTE 35
CANTON NY
13617-3937
US

V. Phone/Fax

Practice location:
  • Phone: 315-250-3904
  • Fax:
Mailing address:
  • Phone: 315-250-3904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number22-507415
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: