Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 71001668A | IN |
NPI | 1033149349 |
---|---|
Provider Name | Gaynell S Pierson |
First Address | Mooresville, IN 46158-1884 |
Second Address | Mooresville, IN 46158-1492 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 23/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q22163 | (02) | IN |