Provider Demographics
NPI:1750732152
Name:TIERNEY-EIDT, ERIN MARIE
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:MARIE
Last Name:TIERNEY-EIDT
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ERIN
Other - Middle Name:MARIE
Other - Last Name:TIERNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:950 ABSEGUAMI TRL
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48362-1453
Mailing Address - Country:US
Mailing Address - Phone:419-297-8259
Mailing Address - Fax:
Practice Address - Street 1:950 ABSEGUAMI TRL
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48362-1453
Practice Address - Country:US
Practice Address - Phone:419-297-8259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other