Provider Demographics
NPI:1962299933
Name:MCDONALD, TIERRA
Entity type:Individual
Prefix:
First Name:TIERRA
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4018 BRADLEY BROWNLEE RD
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44410-9714
Mailing Address - Country:US
Mailing Address - Phone:330-856-0769
Mailing Address - Fax:
Practice Address - Street 1:4018 BRADLEY BROWNLEE RD
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:OH
Practice Address - Zip Code:44410-9714
Practice Address - Country:US
Practice Address - Phone:330-856-0769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist