MEDICARE: MARY PIERSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172A00000X	Driver	56227	ND

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	04966	OTHER	ND	FOSTER PARENT
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962843862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY PIERSON

Provider Business Mailing Address
First Line	:	6735 54TH AVE SW
Second Line	:
City	:	CARSON
State	:	ND
Zip	:	58529
Country	:	US
Telephone Number	:	701-622-3088
Fax Number	:

Provider Business Practice Location Address
First Line	:	6735 54TH AVE SW
Second Line	:
City	:	CARSON
State	:	ND
Zip	:	58529
Country	:	US
Telephone Number	:	701-622-3088
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2013
Last Update Date	:	07/09/2013

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Directions to “ MARY PIERSON ” Practice Location

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