Provider Demographics
NPI:1790452977
Name:PIERCE, IAN MICHEAL (APRN)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:MICHEAL
Last Name:PIERCE
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 PINNACLE DR
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-6242
Mailing Address - Country:US
Mailing Address - Phone:402-268-1212
Mailing Address - Fax:402-502-9177
Practice Address - Street 1:529 PINNACLE DR
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-6242
Practice Address - Country:US
Practice Address - Phone:402-268-1212
Practice Address - Fax:402-502-9177
Is Sole Proprietor?:No
Enumeration Date:2021-08-25
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE113771363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE113771OtherAPRN STATE LICENSE