Provider Demographics
NPI:1740463082
Name:PIERSON, LACEY J (RD)
Entity type:Individual
Prefix:MISS
First Name:LACEY
Middle Name:J
Last Name:PIERSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 SPRING DR
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-3838
Mailing Address - Country:US
Mailing Address - Phone:410-820-9734
Mailing Address - Fax:
Practice Address - Street 1:9733 HEALTHWAY DR
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-1155
Practice Address - Country:US
Practice Address - Phone:410-641-9773
Practice Address - Fax:410-641-9712
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX2774133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered