Basic Information
| Provider Information | |||||||||
| NPI: | 1003547928 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PIERCE | ||||||||
| FirstName: | CAROLYN | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6 WOODLAND RD STE 304 | ||||||||
| Address2: | |||||||||
| City: | SAINT HELENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945749562 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7079637200 | ||||||||
| FaxNumber: | 7079637203 | ||||||||
| Practice Location | |||||||||
| Address1: | 6 WOODLAND RD STE 304 | ||||||||
| Address2: | |||||||||
| City: | SAINT HELENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945749562 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7079637200 | ||||||||
| FaxNumber: | 7079637203 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2022 | ||||||||
| LastUpdateDate: | 06/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 95021354 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.