Provider Demographics
NPI:1154817856
Name:TIERNEY, HEAVEN L (APRN, CNP)
Entity type:Individual
Prefix:
First Name:HEAVEN
Middle Name:L
Last Name:TIERNEY
Suffix:
Gender:
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:HEAVEN
Other - Middle Name:
Other - Last Name:FLEMMING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4913 WESTLUND RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MN
Mailing Address - Zip Code:55779-9781
Mailing Address - Country:US
Mailing Address - Phone:218-830-8000
Mailing Address - Fax:
Practice Address - Street 1:2925 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1321
Practice Address - Country:US
Practice Address - Phone:218-830-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2078221163W00000X
MN5997363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse