Basic Information
Provider Information
NPI: 1578099123
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PIERCE
FirstName: EMMA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 820 SPRINGER DR
Address2:  
City: LOMBARD
State: IL
PostalCode: 601486413
CountryCode: US
TelephoneNumber: 8157448554
FaxNumber:  
Practice Location
Address1: 650 S MOUNT JULIET RD STE 100
Address2:  
City: MT JULIET
State: TN
PostalCode: 371226491
CountryCode: US
TelephoneNumber: 6155532016
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/02/2017
LastUpdateDate: 01/25/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/25/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XARNP9359375FLN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
363LF0000XAPN0000022490TNY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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