Provider Demographics
NPI:1255878518
Name:MANNING, SARAH TIERNEY (PA-C)
Entity type:Individual
Prefix:MISS
First Name:SARAH
Middle Name:TIERNEY
Last Name:MANNING
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TIERNEY
Other - Middle Name:
Other - Last Name:MANNING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:4400 W 95TH ST
Mailing Address - Street 2:SUITE 413
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2654
Mailing Address - Country:US
Mailing Address - Phone:708-346-4055
Mailing Address - Fax:708-499-0948
Practice Address - Street 1:4400 W 95TH ST
Practice Address - Street 2:SUITE 413
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2654
Practice Address - Country:US
Practice Address - Phone:708-346-4055
Practice Address - Fax:708-499-0948
Is Sole Proprietor?:No
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.006078363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant