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General NPI Number Information
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NPI Number | 1134872245
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Entity Type | Individual
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Provider Name | CRYSTAL RAE CLENDENNEN PEIRCE DO
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Gender | Female
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Dates
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Enumeration Date | 01/28/2022
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Last Update Date | 03/23/2023
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Provider Practice Location Address
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Address Line | 677 CHURCH ST NE
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City | MARIETTA
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State | GA
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Zip | 30060-1101
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Country | US
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Telephone | 209-573-6181
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Fax |
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Provider Business Mailing Address
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Address Line | 375 PORTERFIELD RD
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City | PORTER
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State | ME
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Zip | 04068-3636
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Country | US
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Telephone | 801-425-2766
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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