Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 20A13964 | CA |
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 2138 | ME |
NPI | 1346431830 |
---|---|
Provider Name | Dr. Stacey Pierce-Talsma |
First Address | Fairfield, CA 94533-6733 |
Second Address | Fairfield, CA 94533-6733 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2007 |
Last Update Date | 12/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1346431830 | (05) | ME |
1346431830 | ANTHEM (01) | ME |
9838516 | AETNA (01) | ME |
AA239303 | HARVARD PILGRIM HEALTHCARE (01) | ME |