Provider Demographics
NPI:1689257412
Name:PIERCE, ROMY (NONE)
Entity Type:Individual
Prefix:MRS
First Name:ROMY
Middle Name:
Last Name:PIERCE
Suffix:
Gender:F
Credentials:NONE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8400 MENAUL BLVD NE STE F
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-2200
Mailing Address - Country:US
Mailing Address - Phone:505-299-7777
Mailing Address - Fax:505-254-1514
Practice Address - Street 1:8400 MENAUL BLVD NE STE F
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2200
Practice Address - Country:US
Practice Address - Phone:505-299-7777
Practice Address - Fax:505-254-1514
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMHAT0957237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM28538358Medicaid