Provider Demographics
NPI:1053100164
Name:PIERCE, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:PIERCE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2664 N EMERALD DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-8728
Mailing Address - Country:US
Mailing Address - Phone:937-361-5979
Mailing Address - Fax:
Practice Address - Street 1:2664 N EMERALD DR
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-8728
Practice Address - Country:US
Practice Address - Phone:937-361-5979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver