Provider Demographics
NPI:1821038977
Name:PIERCE, VICKI L (NNP-BC)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:L
Last Name:PIERCE
Suffix:
Gender:F
Credentials:NNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 W SHADYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-5014
Mailing Address - Country:US
Mailing Address - Phone:719-671-6629
Mailing Address - Fax:719-671-6629
Practice Address - Street 1:269 S. CANDY LANE
Practice Address - Street 2:VERDE VALLEY MEDICAL CENTER
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326
Practice Address - Country:US
Practice Address - Phone:719-671-6629
Practice Address - Fax:719-671-6629
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC194125363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal