Provider Demographics
NPI:1265400956
Name:PIERSON, JANE R (CRNA)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:R
Last Name:PIERSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 CANTON ST
Mailing Address - Street 2:STE 325
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-2324
Mailing Address - Country:US
Mailing Address - Phone:781-407-7713
Mailing Address - Fax:781-407-0998
Practice Address - Street 1:1245 S CEDAR CREST BLVD STE 301
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6258
Practice Address - Country:US
Practice Address - Phone:610-402-8896
Practice Address - Fax:610-402-8896
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN120979367500000X
PA032027367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1027809230001Medicaid
PA116957OtherGEISINGER
PA2031873000OtherIBC
PA50077556OtherCAPITAL ADVANTAGE
PA2038195OtherFIRST PRIORITY
PA9062445OtherAETNA
PA11879401OtherCAQH
PA1585156OtherGATEWAY
PA2038195OtherHIGHMARK
PA018496Medicare ID - Type Unspecified
PAP00773552Medicare PIN
PA013407QCYMedicare PIN