Provider Demographics
NPI:1790534980
Name:PIERCE, PAIGE (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:PIERCE
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4524 HARVEST LN
Mailing Address - Street 2:
Mailing Address - City:SACHSE
Mailing Address - State:TX
Mailing Address - Zip Code:75048-4696
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4524 HARVEST LN
Practice Address - Street 2:
Practice Address - City:SACHSE
Practice Address - State:TX
Practice Address - Zip Code:75048-4696
Practice Address - Country:US
Practice Address - Phone:214-952-3568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-18
Last Update Date:2024-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT88197133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered