Provider Demographics
NPI:1235915174
Name:PIERCE, WAYNE RICHARD II (FNP)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:RICHARD
Last Name:PIERCE
Suffix:II
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7268 PEAR TREE MDWS
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:NY
Mailing Address - Zip Code:14519-9617
Mailing Address - Country:US
Mailing Address - Phone:585-750-0071
Mailing Address - Fax:
Practice Address - Street 1:1867 EMPIRE BLVD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-1910
Practice Address - Country:US
Practice Address - Phone:585-347-3689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY695759363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily