Basic Information
Provider Information
NPI: 1740773449
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PIERCE
FirstName: ELIZABETH
MiddleName: MARIE
NamePrefix:  
NameSuffix:  
Credential: MSN, FNP-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3030 N CENTRAL AVE STE 1001
Address2:  
City: PHOENIX
State: AZ
PostalCode: 850122716
CountryCode: US
TelephoneNumber: 6024064786
FaxNumber: 9166364358
Practice Location
Address1: 500 W THOMAS RD STE 600
Address2:  
City: PHOENIX
State: AZ
PostalCode: 85013
CountryCode: US
TelephoneNumber: 6024061140
FaxNumber: 6024061149
Other Information
ProviderEnumerationDate: 06/08/2018
LastUpdateDate: 07/26/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XTAP11352AZN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
363LF0000XAP11352AZY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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