Healthcare Provider Details

I. General information

NPI: 1831183425
Provider Name (Legal Business Name): CHRISTINE SUSANNE DONNER-TIERNAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 SECOND ST
WEBSTER CITY IA
50595-1345
US

IV. Provider business mailing address

232 10TH AVE N
FORT DODGE IA
50501-2425
US

V. Phone/Fax

Practice location:
  • Phone: 515-832-4025
  • Fax:
Mailing address:
  • Phone: 515-955-8635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19439
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11490
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: