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NPI Code Detail

MEDICARE: MICHELLE LAUREN TIERNEY

MEDICARE: MICHELLE LAUREN TIERNEY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207L00000XAnesthesiology Physician11712AZ

General Provider Information

NPI Number : 1750963484
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE LAUREN TIERNEY
Provider Business Mailing Address
First Line : 6000 BUCKHORN LAKE RD
Second Line :
City : HIGHLAND
State : MI
Zip : 48357-2314
Country : US
Telephone Number : 248-660-3563
Fax Number :
Provider Business Practice Location Address
First Line : 1200 N BEAVER ST
Second Line :
City : FLAGSTAFF
State : AZ
Zip : 86001-3118
Country : US
Telephone Number : 928-214-2920
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/22/2021
Last Update Date : 05/11/2026

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Directions to “ MICHELLE LAUREN TIERNEY ” Practice Location

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