Provider Demographics
NPI:1467261404
Name:PIERCE, XANDREA
Entity type:Individual
Prefix:
First Name:XANDREA
Middle Name:
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 1:4510 S EASTERN AVE STE 9
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6118
Mailing Address - Country:US
Mailing Address - Phone:725-204-0692
Mailing Address - Fax:
Practice Address - Street 1:4510 S EASTERN AVE STE 9
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6118
Practice Address - Country:US
Practice Address - Phone:725-204-0692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-03
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV29D2237648291U00000X
3295-43378939246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No291U00000XLaboratoriesClinical Medical Laboratory