Provider Demographics
NPI:1891027959
Name:PIERCE, CLINTON D (LPN)
Entity type:Individual
Prefix:MR
First Name:CLINTON
Middle Name:D
Last Name:PIERCE
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3563 BAINBRIDGE AVE
Mailing Address - Street 2:4-B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-1407
Mailing Address - Country:US
Mailing Address - Phone:347-346-3179
Mailing Address - Fax:
Practice Address - Street 1:3563 BAINBRIDGE AVE
Practice Address - Street 2:4-B
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-1407
Practice Address - Country:US
Practice Address - Phone:347-346-3179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY089632164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse