=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487132312
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANA MICHELLE PIERCE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2018
-----------------------------------------------------
Last Update Date | 08/02/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6559 WILSON MILLS RD
-----------------------------------------------------
City | MAYFIELD VILLAGE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44143-6402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-449-1540
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 108 W POINTE CT
-----------------------------------------------------
City | CHARDON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44024-2810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-668-7020
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 023305
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------