Provider Demographics
NPI:1720604176
Name:PEARCE, CORINNE (RD)
Entity Type:Individual
Prefix:MISS
First Name:CORINNE
Middle Name:
Last Name:PEARCE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5806 MAGNOLIA CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT LEONARD
Mailing Address - State:MD
Mailing Address - Zip Code:20685-2722
Mailing Address - Country:US
Mailing Address - Phone:202-528-0875
Mailing Address - Fax:
Practice Address - Street 1:5806 MAGNOLIA CIR
Practice Address - Street 2:
Practice Address - City:SAINT LEONARD
Practice Address - State:MD
Practice Address - Zip Code:20685-2722
Practice Address - Country:US
Practice Address - Phone:202-528-0875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX3186133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered