Provider Demographics
NPI:1033451901
Name:PIERCE, JENNIFER LINDA (RN)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LINDA
Last Name:PIERCE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 COUNTY ROUTE 35
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:NY
Mailing Address - Zip Code:13617-3937
Mailing Address - Country:US
Mailing Address - Phone:315-250-3904
Mailing Address - Fax:
Practice Address - Street 1:1255 COUNTY ROUTE 35
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:NY
Practice Address - Zip Code:13617-3937
Practice Address - Country:US
Practice Address - Phone:315-250-3904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22-507415163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY22-507415OtherREGISTERED PROFESSIONAL NURSING