Individual
PATIENCE TIERI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2490 CENTRAL AVE, LAKE STATION, IN 46405
(219) 763-8112
(219) 962-1580
Mailing address
PO BOX 1430, PORTAGE, IN 46368-9230
(219) 763-8112
(219) 764-5380
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71007027A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300001810
—
IN
Enumeration date
04/06/2017
Last updated
07/23/2018
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