Provider Demographics
NPI:1528394897
Name:TIERNEY, ANNE MARIE I (RN)
Entity Type:Individual
Prefix:MISS
First Name:ANNE
Middle Name:MARIE
Last Name:TIERNEY
Suffix:I
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:ANNE
Other - Middle Name:MARIE
Other - Last Name:ALCALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:137 MONTEREY DR
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-2315
Mailing Address - Country:US
Mailing Address - Phone:630-410-8934
Mailing Address - Fax:
Practice Address - Street 1:137 MONTEREY DR
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-2315
Practice Address - Country:US
Practice Address - Phone:630-410-8934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041339553163W00000X
WI154353-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse