Basic Information
Provider Information
NPI: 1518127869
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PIERRE-PAUL
FirstName: NANCY
MiddleName: MARIE
NamePrefix:  
NameSuffix:  
Credential: FNP-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 604 ROSE AVE
Address2:  
City: VENICE
State: CA
PostalCode: 902912767
CountryCode: US
TelephoneNumber: 3103928636
FaxNumber:  
Practice Location
Address1: 604 ROSE AVE
Address2:  
City: VENICE
State: CA
PostalCode: 902912767
CountryCode: US
TelephoneNumber: 3103928636
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/10/2008
LastUpdateDate: 03/04/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/04/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XNP 18054CAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


Home