Provider Demographics
NPI:1497188619
Name:TIERNAN-LANG, SHARON D (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:D
Last Name:TIERNAN-LANG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 453
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:CA
Mailing Address - Zip Code:95625-0453
Mailing Address - Country:US
Mailing Address - Phone:707-469-8699
Mailing Address - Fax:
Practice Address - Street 1:5701 8TH ST
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-3305
Practice Address - Country:US
Practice Address - Phone:925-833-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1034001OtherNCCPA