Provider Demographics
NPI:1811252984
Name:PEARCE, KRISTEN
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:PEARCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5962 STATE ROUTE 31
Mailing Address - Street 2:BOX 10
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-8800
Mailing Address - Country:US
Mailing Address - Phone:315-698-0033
Mailing Address - Fax:315-698-0031
Practice Address - Street 1:5962 STATE ROUTE 31
Practice Address - Street 2:BOX 10
Practice Address - City:CICERO
Practice Address - State:NY
Practice Address - Zip Code:13039-8800
Practice Address - Country:US
Practice Address - Phone:315-698-0033
Practice Address - Fax:315-698-0031
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator