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General NPI Number Information
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NPI Number | 1063704203
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Entity Type | Organization
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Legal Business Name | NURSE PRACTITIONER ALLIANCE LLC
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Dates
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Enumeration Date | 05/05/2011
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Last Update Date | 05/02/2012
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Provider Practice Location Address
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Address Line | 7326 STATE ROUTE 19 UNIT 5416
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City | MOUNT GILEAD
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State | OH
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Zip | 43338-9354
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Country | US
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Telephone | 419-528-9333
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Fax |
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Provider Business Mailing Address
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Address Line | 7326 STATE ROUTE 19 UNIT 5416
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City | MOUNT GILEAD
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State | OH
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Zip | 43338-9349
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Country | US
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Telephone | 419-528-9333
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MRS. DONNA FAY PIERCE
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Credential | NP
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Telephone | 419-528-9333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 11665
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License Number State | OH
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