Provider Demographics
NPI:1457060238
Name:PIERRE, PENDJY X (LN)
Entity Type:Individual
Prefix:
First Name:PENDJY
Middle Name:
Last Name:PIERRE
Suffix:X
Gender:F
Credentials:LN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 FERNWOOD DR # CONDOD
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-1968
Mailing Address - Country:US
Mailing Address - Phone:978-728-2686
Mailing Address - Fax:
Practice Address - Street 1:17 FERNWOOD DR # CONDOD
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-1968
Practice Address - Country:US
Practice Address - Phone:978-728-2686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN85204164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse