Provider Demographics
NPI:1972831873
Name:DOVAN, TIERNEY O'BRIEN (CPM)
Entity Type:Individual
Prefix:
First Name:TIERNEY
Middle Name:O'BRIEN
Last Name:DOVAN
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 THE DELL LN
Mailing Address - Street 2:
Mailing Address - City:HUME
Mailing Address - State:VA
Mailing Address - Zip Code:22639-1735
Mailing Address - Country:US
Mailing Address - Phone:540-229-4750
Mailing Address - Fax:
Practice Address - Street 1:4901 THE DELL LN
Practice Address - Street 2:
Practice Address - City:HUME
Practice Address - State:VA
Practice Address - Zip Code:22639-1735
Practice Address - Country:US
Practice Address - Phone:540-229-4750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-03
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0129000040176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife