Provider Demographics
NPI:1033200845
Name:PIERCE, MARK J (APRN)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:PIERCE
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:104 WHITMAN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-1754
Mailing Address - Country:US
Mailing Address - Phone:860-233-6296
Mailing Address - Fax:
Practice Address - Street 1:1030 NEW BRITAIN AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06110-2261
Practice Address - Country:US
Practice Address - Phone:860-947-2308
Practice Address - Fax:860-947-2309
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT001818363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily