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Individual
TIERNEY ROSE LARA
Active
Individual
TIERNEY ROSE LARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
28188051A
IN
363LF0000X
Family Nurse Practitioner
Primary
F06190055
IN
Other
Enumeration date
01/28/2019
Last updated
12/23/2019
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