Provider Demographics
NPI:1881847564
Name:TIERNEY, CHRISTINE LYN
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:LYN
Last Name:TIERNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 INTERLAKEN CT UNIT 8
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-3921
Mailing Address - Country:US
Mailing Address - Phone:732-303-7947
Mailing Address - Fax:
Practice Address - Street 1:3155 AMBOY RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2799
Practice Address - Country:US
Practice Address - Phone:718-313-1470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY519200-1163W00000X
NJ26NR11417800163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse