Provider Demographics
NPI:1962026427
Name:PIERCE, KATRINA M (RN-BC)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:M
Last Name:PIERCE
Suffix:
Gender:F
Credentials:RN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 SOUTHWYK RD
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-8850
Mailing Address - Country:US
Mailing Address - Phone:302-229-6555
Mailing Address - Fax:302-229-6555
Practice Address - Street 1:213 SOUTHWYK RD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-8850
Practice Address - Country:US
Practice Address - Phone:302-229-6555
Practice Address - Fax:302-229-6555
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-01
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0037782163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0413733Medicaid