Individual
MARY PIERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6735 54TH AVE SW, CARSON, ND 58529
(701) 622-3088
Mailing address
6735 54TH AVE SW, CARSON, ND 58529
(701) 622-3088
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
56227
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04966
FOSTER PARENT
ND
01
—
56227
MEDICAID TRANSPORTATION PROVIDER
ND
Enumeration date
07/09/2013
Last updated
07/09/2013
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