Provider Demographics
NPI:1841395605
Name:PIERCE, PAULA (CNM)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:PIERCE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:598 CYNWOOD DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-3875
Mailing Address - Country:US
Mailing Address - Phone:410-822-1221
Mailing Address - Fax:410-819-8149
Practice Address - Street 1:598 CYNWOOD DR
Practice Address - Street 2:SUITE 105
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-3875
Practice Address - Country:US
Practice Address - Phone:410-822-1221
Practice Address - Fax:410-819-8149
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR192773367A00000X
CT000128367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT00417882901Medicaid
CTS24232Medicare UPIN