Provider Demographics
NPI:1992201776
Name:PEIRCE, KRYSTAL (RN, BSN,MSN)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:
Last Name:PEIRCE
Suffix:
Gender:F
Credentials:RN, BSN,MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4069 SHERMAN OAKS AVE
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-5728
Mailing Address - Country:US
Mailing Address - Phone:781-267-5841
Mailing Address - Fax:
Practice Address - Street 1:4069 SHERMAN OAKS AVE
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-5728
Practice Address - Country:US
Practice Address - Phone:781-267-5841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-02
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2282055163WP0809X
NH081650-21163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult