Individual
KIM TIERNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
398 NEPONSET AVE, DORCHESTER, MA 02122-3134
(617) 282-3200
Mailing address
215 NEPONSET AVE, #2, DORCHESTER, MA 02122-3225
(619) 980-6182
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN2263616
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
M20396
MA MEDICARE
MA
Enumeration date
09/30/2015
Last updated
09/30/2015
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