Provider Demographics
NPI:1083027841
Name:PIERRE VICIERE, PAULA
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:PIERRE VICIERE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 KENILWORTH PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-2328
Mailing Address - Country:US
Mailing Address - Phone:347-770-8512
Mailing Address - Fax:
Practice Address - Street 1:34 KENILWORTH PL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-2328
Practice Address - Country:US
Practice Address - Phone:347-770-8512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY314128-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse