MEDICARE: ANDREA PIERSON RN

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	163WD0400X	Diabetes Educator Registered Nurse	R100672-8	MN

General Provider Information

NPI Number	:	1992241590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA PIERSON RN

Provider Business Mailing Address
First Line	:	1185 TOWN CENTRE DR STE 220
Second Line	:
City	:	EAGAN
State	:	MN
Zip	:	55123-1186
Country	:	US
Telephone Number	:	651-379-1600
Fax Number	:

Provider Business Practice Location Address
First Line	:	1185 TOWN CENTRE DR STE 220
Second Line	:
City	:	EAGAN
State	:	MN
Zip	:	55123-1186
Country	:	US
Telephone Number	:	651-379-1600
Fax Number	:

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

Provider Enumeration Date	:	01/06/2017
Last Update Date	:	01/06/2017

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