Provider Demographics
NPI:1689226441
Name:ELISON, TIERNEY KATHLEEN (CNM)
Entity Type:Individual
Prefix:MRS
First Name:TIERNEY
Middle Name:KATHLEEN
Last Name:ELISON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 UNION ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01901-1353
Mailing Address - Country:US
Mailing Address - Phone:781-596-3800
Mailing Address - Fax:
Practice Address - Street 1:280 UNION ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1353
Practice Address - Country:US
Practice Address - Phone:781-596-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-11
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPENDING367A00000X
RICNM00183367A00000X
MARN2318216367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MARN231826OtherMASSACHUSETTS BOARD OF NURSING