Basic Information
| Provider Information | |||||||||
| NPI: | 1487132312 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PIERCE | ||||||||
| FirstName: | DANA | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 108 W POINTE CT | ||||||||
| Address2: | |||||||||
| City: | CHARDON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440242810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4406687020 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6559 WILSON MILLS RD | ||||||||
| Address2: | |||||||||
| City: | MAYFIELD VILLAGE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441436402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4404491540 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2018 | ||||||||
| LastUpdateDate: | 08/02/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 023305 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 14302124 | 05 | OH | MEDICAID |