Individual
DR. SHANNON MARIE TIERNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-7335
(208) 381-7227
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-8752
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
M-17856
ID
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/15/2019
Last updated
08/06/2024
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