Provider Demographics
NPI:1063704203
Name:NURSE PRACTITIONER ALLIANCE LLC
Entity type:Organization
Organization Name:NURSE PRACTITIONER ALLIANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:FAY
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:419-528-9333
Mailing Address - Street 1:7326 STATE ROUTE 19 UNIT 5416
Mailing Address - Street 2:
Mailing Address - City:MOUNT GILEAD
Mailing Address - State:OH
Mailing Address - Zip Code:43338-9349
Mailing Address - Country:US
Mailing Address - Phone:419-528-9333
Mailing Address - Fax:
Practice Address - Street 1:7326 STATE ROUTE 19
Practice Address - Street 2:UNIT 5416
Practice Address - City:MOUNT GILEAD
Practice Address - State:OH
Practice Address - Zip Code:43338-9354
Practice Address - Country:US
Practice Address - Phone:419-528-9333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-05
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH11665363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9395201OtherMEDICARE PTAN