Provider Demographics
NPI:1093780025
Name:PIERCE, NATALIE NICOLE (PA)
Entity Type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:NICOLE
Last Name:PIERCE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 E MAIN ST
Mailing Address - Street 2:PO BOX 10
Mailing Address - City:WESTFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14787-1121
Mailing Address - Country:US
Mailing Address - Phone:716-326-4678
Mailing Address - Fax:716-326-4914
Practice Address - Street 1:115 EAST MAIN ST
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:NY
Practice Address - Zip Code:14781
Practice Address - Country:US
Practice Address - Phone:716-761-6144
Practice Address - Fax:716-326-4914
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006851363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02153579Medicaid
NYS74855Medicare UPIN
NYCC4882Medicare ID - Type Unspecified