Provider Demographics
NPI:1356629067
Name:KIERNAN, PATRICIA N (RN)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:N
Last Name:KIERNAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 BERKSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-2309
Mailing Address - Country:US
Mailing Address - Phone:609-226-8353
Mailing Address - Fax:609-601-7612
Practice Address - Street 1:106 BERKSHIRE AVE
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-2309
Practice Address - Country:US
Practice Address - Phone:609-226-8353
Practice Address - Fax:609-601-7612
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-29
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR08572200163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse