Individual
KRISTINE TIERNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
9301 CONNECTICUT DR, CROWN POINT, IN 46307-7486
(547) 596-9558
Mailing address
1004 PARKWAY AVE, ELKHART, IN 46516-9348
(574) 596-9558
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041.368412
IL
163W00000X
Registered Nurse
28227179A
IN
367500000X
Certified Registered Nurse Anesthetist
Primary
28227179A
IN
Other
Enumeration date
08/09/2017
Last updated
09/28/2020
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