Provider Demographics
NPI:1043424070
Name:PIERCE, ANTONICE MONIQUE (LPN)
Entity Type:Individual
Prefix:
First Name:ANTONICE
Middle Name:MONIQUE
Last Name:PIERCE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33001 VINE ST
Mailing Address - Street 2:E-13
Mailing Address - City:WILLOWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44095-3354
Mailing Address - Country:US
Mailing Address - Phone:216-322-7960
Mailing Address - Fax:
Practice Address - Street 1:33001 VINE ST
Practice Address - Street 2:E-13
Practice Address - City:WILLOWICK
Practice Address - State:OH
Practice Address - Zip Code:44095-3354
Practice Address - Country:US
Practice Address - Phone:216-322-7960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 112153164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse