Provider Demographics
NPI:1508083734
Name:PIERCE, DOROTHY NERESSA (APN-C)
Entity Type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:NERESSA
Last Name:PIERCE
Suffix:
Gender:F
Credentials:APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 FLORENCE CT
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527
Mailing Address - Country:US
Mailing Address - Phone:732-363-7155
Mailing Address - Fax:732-886-1221
Practice Address - Street 1:1ROBERT WOOD JOHNSON PLACE
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08903-2601
Practice Address - Country:US
Practice Address - Phone:732-253-3939
Practice Address - Fax:732-253-3952
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00127300363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0185370Medicaid
NJ0185370Medicaid