Provider Demographics
NPI:1538992995
Name:TIERNAN, DEANNA MARIE
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:MARIE
Last Name:TIERNAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 CONOWINGO CIR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19363-1486
Mailing Address - Country:US
Mailing Address - Phone:484-841-3715
Mailing Address - Fax:
Practice Address - Street 1:432 CONOWINGO CIR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:PA
Practice Address - Zip Code:19363-1486
Practice Address - Country:US
Practice Address - Phone:484-841-3715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN322931164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse