Provider Demographics
NPI:1013912294
Name:PIERCE, DONALD LEE (FNP)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:LEE
Last Name:PIERCE
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 N PEARL LN
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-7931
Mailing Address - Country:US
Mailing Address - Phone:602-526-0628
Mailing Address - Fax:
Practice Address - Street 1:1812 N PEARL LN
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-7931
Practice Address - Country:US
Practice Address - Phone:602-526-0628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ638363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP52584Medicare UPIN