Provider Demographics
NPI:1962583617
Name:PIERNOT, ELLEN E (MD)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:E
Last Name:PIERNOT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2927 MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-2516
Mailing Address - Country:US
Mailing Address - Phone:505-415-0772
Mailing Address - Fax:
Practice Address - Street 1:737 W CHILDS AVE
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95341-6805
Practice Address - Country:US
Practice Address - Phone:209-385-5481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ48550207Q00000X
NMMD20070158207Q00000X
WI48578-020207Q00000X
CAC135085207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM60906308Medicaid
WI34697200Medicaid
WII44824Medicare UPIN
WI34697200Medicaid