Provider Demographics
NPI:1497027353
Name:PIERCE, STEPHANIE JOHANNA (RN)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:JOHANNA
Last Name:PIERCE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:NY
Mailing Address - Zip Code:14715-1235
Mailing Address - Country:US
Mailing Address - Phone:585-928-2881
Mailing Address - Fax:585-928-1113
Practice Address - Street 1:211 MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHBURG
Practice Address - State:NY
Practice Address - Zip Code:14774
Practice Address - Country:US
Practice Address - Phone:585-928-2881
Practice Address - Fax:585-928-1113
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY590831163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool