Provider Demographics
NPI:1003433723
Name:PEARCE, DALE D (APRN, FNP-C)
Entity Type:Individual
Prefix:MR
First Name:DALE
Middle Name:D
Last Name:PEARCE
Suffix:
Gender:M
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 E 200 AVE
Mailing Address - Street 2:
Mailing Address - City:PATOKA
Mailing Address - State:IL
Mailing Address - Zip Code:62875-0045
Mailing Address - Country:US
Mailing Address - Phone:618-322-8391
Mailing Address - Fax:
Practice Address - Street 1:1535 W MCCORD ST
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801-5805
Practice Address - Country:US
Practice Address - Phone:618-533-1811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-29
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209020476363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily