Provider Demographics
NPI:1598012494
Name:TIERNEY, LEANNE M (LPN)
Entity Type:Individual
Prefix:MS
First Name:LEANNE
Middle Name:M
Last Name:TIERNEY
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 1:730 WOODGATE BLVD
Mailing Address - Street 2:APT 103
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-4134
Mailing Address - Country:US
Mailing Address - Phone:330-677-0214
Mailing Address - Fax:330-839-8398
Practice Address - Street 1:730 WOODGATE BLVD
Practice Address - Street 2:APT 103
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-4134
Practice Address - Country:US
Practice Address - Phone:330-677-0214
Practice Address - Fax:330-839-8398
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.144542164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse