Provider Demographics
NPI:1154891059
Name:PIERCE, HEATHER NOEL
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:NOEL
Last Name:PIERCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1732 S AGATE SHORE DR SW
Mailing Address - Street 2:
Mailing Address - City:NISSWA
Mailing Address - State:MN
Mailing Address - Zip Code:56468-2043
Mailing Address - Country:US
Mailing Address - Phone:763-276-4503
Mailing Address - Fax:
Practice Address - Street 1:1732 S AGATE SHORE DR SW
Practice Address - Street 2:
Practice Address - City:NISSWA
Practice Address - State:MN
Practice Address - Zip Code:56468-2043
Practice Address - Country:US
Practice Address - Phone:763-276-4503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-04
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer