Provider Demographics
NPI:1093479123
Name:PIERCE, BARBRA F (APRN, FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:BARBRA
Middle Name:F
Last Name:PIERCE
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32918 N BATTERSHALL RD
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-2005
Mailing Address - Country:US
Mailing Address - Phone:847-293-1924
Mailing Address - Fax:
Practice Address - Street 1:201 S MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:LAKE VILLA
Practice Address - State:IL
Practice Address - Zip Code:60046-8551
Practice Address - Country:US
Practice Address - Phone:847-356-9009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209019529363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL032453Medicaid