Healthcare Provider Details

I. General information

NPI: 1730149881
Provider Name (Legal Business Name): VICTORIA J PIERCE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 12/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 MICHIGAN ST
SIDNEY OH
45365-2401
US

IV. Provider business mailing address

1121 ONTARIO CT
SIDNEY OH
45365-8197
US

V. Phone/Fax

Practice location:
  • Phone: 937-498-5440
  • Fax:
Mailing address:
  • Phone: 937-710-4102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN-226605
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: