Provider Demographics
NPI:1710102991
Name:TIREY, TIERNEY LYNNE (MD)
Entity Type:Individual
Prefix:DR
First Name:TIERNEY
Middle Name:LYNNE
Last Name:TIREY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 CIVIC CENTER DR
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-7113
Mailing Address - Country:US
Mailing Address - Phone:702-642-8313
Mailing Address - Fax:702-642-8903
Practice Address - Street 1:1825 CIVIC CENTER DR
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-7113
Practice Address - Country:US
Practice Address - Phone:702-642-8313
Practice Address - Fax:702-642-8903
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5410208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2019510Medicaid
NVV39600Medicare ID - Type Unspecified
NVE01213Medicare UPIN