Provider Demographics
NPI:1194059865
Name:TIERNEY, NICOLE LYNNE (RD)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:LYNNE
Last Name:TIERNEY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 BV FRENCH ST
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-4850
Mailing Address - Country:US
Mailing Address - Phone:508-944-2485
Mailing Address - Fax:
Practice Address - Street 1:46 BV FRENCH ST
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-4850
Practice Address - Country:US
Practice Address - Phone:508-944-2485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-28
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2917133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered