1508405234 NPI number — LAURA RENEE PIERCE LMT

Table of content: LAURA RENEE PIERCE LMT (NPI 1508405234)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508405234 NPI number — LAURA RENEE PIERCE LMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PIERCE
Provider First Name:
LAURA
Provider Middle Name:
RENEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508405234
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/28/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4488 W BROAD ST STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43228-5610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-237-6373
Provider Business Mailing Address Fax Number:
614-853-2444

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2691 E MAIN ST STE 204
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEXLEY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43209-2535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-237-6373
Provider Business Practice Location Address Fax Number:
614-853-2444
Provider Enumeration Date:
12/28/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  33022779 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 33022779 . This is a "LICENSE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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