Healthcare Provider Details

I. General information

NPI: 1992201776
Provider Name (Legal Business Name): KRYSTAL PEIRCE RN, BSN,MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 11/20/2020
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4069 SHERMAN OAKS AVE
VIRGINIA BEACH VA
23456-5728
US

IV. Provider business mailing address

4069 SHERMAN OAKS AVE
VIRGINIA BEACH VA
23456-5728
US

V. Phone/Fax

Practice location:
  • Phone: 781-267-5841
  • Fax:
Mailing address:
  • Phone: 781-267-5841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN2282055
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number081650-21
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: