Provider Demographics
NPI:1508623117
Name:PIERCE, JESSE L SR
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:L
Last Name:PIERCE
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 2ND ST W
Mailing Address - Street 2:
Mailing Address - City:NAPOLEON
Mailing Address - State:ND
Mailing Address - Zip Code:58561-7026
Mailing Address - Country:US
Mailing Address - Phone:425-524-8054
Mailing Address - Fax:
Practice Address - Street 1:314 2ND ST W
Practice Address - Street 2:
Practice Address - City:NAPOLEON
Practice Address - State:ND
Practice Address - Zip Code:58561-7026
Practice Address - Country:US
Practice Address - Phone:425-524-8054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant