Provider Demographics
NPI:1447752704
Name:PIERSON, TAMMY JEAN (LPN)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:JEAN
Last Name:PIERSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:JEAN
Other - Last Name:CARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:4372 OLD COLONY DR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-3538
Mailing Address - Country:US
Mailing Address - Phone:989-992-6133
Mailing Address - Fax:
Practice Address - Street 1:4372 OLD COLONY DR
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-3538
Practice Address - Country:US
Practice Address - Phone:989-992-6133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-02
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703106534164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse