Provider Demographics
NPI:1073230199
Name:KNOX, TIERRA MONE (LPN)
Entity Type:Individual
Prefix:
First Name:TIERRA
Middle Name:MONE
Last Name:KNOX
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 WESTCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-4531
Mailing Address - Country:US
Mailing Address - Phone:716-861-6157
Mailing Address - Fax:
Practice Address - Street 1:500 SENECA ST STE 610
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14204-1963
Practice Address - Country:US
Practice Address - Phone:716-881-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332837-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse