Healthcare Provider Details

I. General information

NPI: 1184342057
Provider Name (Legal Business Name): TIERNEY BOIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2022
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 JACKSON ST
LOWELL MA
01852-2103
US

IV. Provider business mailing address

199 BOSTON RD
NORTH BILLERICA MA
01862-2328
US

V. Phone/Fax

Practice location:
  • Phone: 978-937-9700
  • Fax: 978-221-6728
Mailing address:
  • Phone: 978-670-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2294914
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: