Healthcare Provider Details

I. General information

NPI: 1699345306
Provider Name (Legal Business Name): DANIELLE LAUREN TIERNEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2021
Last Update Date: 05/27/2022
Certification Date: 05/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 TURNPIKE RD
SOUTHBOROUGH MA
01772-2108
US

IV. Provider business mailing address

17 LAKEVIEW AVE
NATICK MA
01760-4251
US

V. Phone/Fax

Practice location:
  • Phone: 508-481-1015
  • Fax:
Mailing address:
  • Phone: 315-420-2001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2269978
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN2269978
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: