Provider Demographics
NPI:1649965161
Name:ERICA PIERCE RENAL RD LLC
Entity type:Organization
Organization Name:ERICA PIERCE RENAL RD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-290-6216
Mailing Address - Street 1:4381 SCOTT CARPENTER DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-9005
Mailing Address - Country:US
Mailing Address - Phone:517-290-6216
Mailing Address - Fax:
Practice Address - Street 1:4381 SCOTT CARPENTER DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-9005
Practice Address - Country:US
Practice Address - Phone:517-290-6216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty