Provider Demographics
NPI:1629022124
Name:PIERCE, TRUDY ALIX (CRNA)
Entity Type:Individual
Prefix:
First Name:TRUDY
Middle Name:ALIX
Last Name:PIERCE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:TRUDY
Other - Middle Name:
Other - Last Name:ALIX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:43 WISHING WELL WAY
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-4363
Mailing Address - Country:US
Mailing Address - Phone:413-785-1327
Mailing Address - Fax:413-785-1327
Practice Address - Street 1:43 WISHING WELL WAY
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-4363
Practice Address - Country:US
Practice Address - Phone:413-785-1327
Practice Address - Fax:413-785-1327
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA174437367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered