Basic Information
| Provider Information | |||||||||
| NPI: | 1437638210 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PIERCE | ||||||||
| FirstName: | CRAIG | ||||||||
| MiddleName: | AARON | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11031 COLOMBUS DR | ||||||||
| Address2: | |||||||||
| City: | FERRYVILLE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 546288106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6086483923 | ||||||||
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| Practice Location | |||||||||
| Address1: | 507 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | VIROQUA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 546652059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6086372101 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2018 | ||||||||
| LastUpdateDate: | 08/12/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 4484-23 | WI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.