Provider Demographics
NPI:1801310255
Name:NESBIT, PIERRE M (MED, ATC, CES)
Entity type:Individual
Prefix:
First Name:PIERRE
Middle Name:M
Last Name:NESBIT
Suffix:
Gender:M
Credentials:MED, ATC, CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3825 CEDAR GROVE PKWY APT 303
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-1458
Mailing Address - Country:US
Mailing Address - Phone:773-603-5296
Mailing Address - Fax:
Practice Address - Street 1:1200 S STATE ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-2203
Practice Address - Country:US
Practice Address - Phone:773-603-5296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-27
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN29172255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
22OtherRESPIRATORY, REHABILITATIVE & RESTORATIVE SERVICE PROVIDERS