Provider Demographics
NPI:1255329850
Name:PIERCE, LINDA RAE (CNP)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:RAE
Last Name:PIERCE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MRS
Other - First Name:LINDA
Other - Middle Name:RAE
Other - Last Name:PIERCE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP-BC
Mailing Address - Street 1:15100 NW 48TH ST
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:NE
Mailing Address - Zip Code:68428-4000
Mailing Address - Country:US
Mailing Address - Phone:402-783-0314
Mailing Address - Fax:402-470-7810
Practice Address - Street 1:15100 NW 48TH ST
Practice Address - Street 2:
Practice Address - City:RAYMOND
Practice Address - State:NE
Practice Address - Zip Code:68428-4000
Practice Address - Country:US
Practice Address - Phone:402-783-0314
Practice Address - Fax:402-783-0314
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110174363LG0600X, 363LW0102X, 363LW0102X
AZAP1820363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ47063549900Medicaid
AZ47063549900Medicaid
AZ267646PIMedicare ID - Type Unspecified