Provider Demographics
NPI:1144622796
Name:PEARSE, TIANNA MARIE
Entity Type:Individual
Prefix:
First Name:TIANNA
Middle Name:MARIE
Last Name:PEARSE
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 1:31465 TYLER ST
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:MI
Mailing Address - Zip Code:48184-2239
Mailing Address - Country:US
Mailing Address - Phone:734-419-3915
Mailing Address - Fax:
Practice Address - Street 1:31465 TYLER ST
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:MI
Practice Address - Zip Code:48184-2239
Practice Address - Country:US
Practice Address - Phone:734-419-3915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other