Provider Demographics
NPI:1245227917
Name:PIERI, LAURA ANN (MD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:PIERI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10622 N SADDLE PASS RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-4504
Mailing Address - Country:US
Mailing Address - Phone:928-708-1697
Mailing Address - Fax:
Practice Address - Street 1:642 DAMERON DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-2411
Practice Address - Country:US
Practice Address - Phone:928-445-5211
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ295202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ716863Medicaid
AZ716863Medicaid
76125Medicare ID - Type Unspecified