Provider Demographics
NPI:1336667518
Name:PIERCE, DEANNA
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:PIERCE
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:PO BOX 531124
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33153-1124
Mailing Address - Country:US
Mailing Address - Phone:888-466-0012
Mailing Address - Fax:954-656-1074
Practice Address - Street 1:2376 NW 95TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33147-2462
Practice Address - Country:US
Practice Address - Phone:888-466-0012
Practice Address - Fax:954-656-1074
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor