Provider Demographics
NPI:1124495429
Name:PIERRE, NIXON (RT(R)(CT)MR))
Entity type:Individual
Prefix:
First Name:NIXON
Middle Name:
Last Name:PIERRE
Suffix:
Gender:M
Credentials:RT(R)(CT)MR)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5393 HIDDEN STREAM DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27023-9807
Mailing Address - Country:US
Mailing Address - Phone:336-837-8609
Mailing Address - Fax:
Practice Address - Street 1:5393 HIDDEN STREAM DR
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27023-9807
Practice Address - Country:US
Practice Address - Phone:336-837-8609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-21
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC509885247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist