Provider Demographics
NPI:1306938030
Name:PIERCE, ANTHONY ALAN (GNP)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:ALAN
Last Name:PIERCE
Suffix:
Gender:M
Credentials:GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4692 BROWNSBORO ROAD
Mailing Address - Street 2:
Mailing Address - City:WINSTON - SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106
Mailing Address - Country:US
Mailing Address - Phone:336-251-1114
Mailing Address - Fax:336-251-1116
Practice Address - Street 1:4692 BROWNSBORO ROAD
Practice Address - Street 2:
Practice Address - City:WINSTON - SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106
Practice Address - Country:US
Practice Address - Phone:336-251-1114
Practice Address - Fax:336-251-1116
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC080467363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCS61605Medicare UPIN
NC2597889AMedicare ID - Type Unspecified