Provider Demographics
NPI:1881837029
Name:PIERCE, LILLIE LANETTE
Entity Type:Individual
Prefix:MRS
First Name:LILLIE
Middle Name:LANETTE
Last Name:PIERCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 E CHAPMAN AVE
Mailing Address - Street 2:# 203
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-3839
Mailing Address - Country:US
Mailing Address - Phone:310-408-6832
Mailing Address - Fax:
Practice Address - Street 1:801 E. CHAPMAN AVE.
Practice Address - Street 2:# 203
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831
Practice Address - Country:US
Practice Address - Phone:310-408-6832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-17
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker