Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | AP143218 | TX |
NPI | 1013504299 |
---|---|
Provider Name | Mrs. Desirae Nicole Pierce |
First Address | Chula Vista, CA 91915-2232 |
Second Address | San Diego, CA 92134-1098 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2020 |
Last Update Date | 22/12/2020 |