Provider Demographics
NPI:1366430621
Name:PIERCE, ANNE (RN, CNP)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:PIERCE
Suffix:
Gender:F
Credentials:RN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12135 24TH AVE N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-4123
Mailing Address - Country:US
Mailing Address - Phone:763-559-4437
Mailing Address - Fax:
Practice Address - Street 1:5520 RIDGEWOOD CV
Practice Address - Street 2:
Practice Address - City:MINNETRISTA
Practice Address - State:MN
Practice Address - Zip Code:55364-8239
Practice Address - Country:US
Practice Address - Phone:612-865-5262
Practice Address - Fax:952-472-3837
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR63909-9363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN109276600Medicaid
MNQ32197Medicare UPIN
MN109276600Medicaid