Healthcare Provider Details

I. General information

NPI: 1609448992
Provider Name (Legal Business Name): SEAN MICHAEL CHRISTOPHER PIERCE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2021
Last Update Date: 05/13/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 E 1ST ST
DAYTON OH
45402-1303
US

IV. Provider business mailing address

PO BOX 933421
CLEVELAND OH
44193-0039
US

V. Phone/Fax

Practice location:
  • Phone: 937-641-4040
  • Fax: 937-641-3066
Mailing address:
  • Phone: 937-641-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0029462
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: