Healthcare Provider Details

I. General information

NPI: 1770401234
Provider Name (Legal Business Name): REBECCA L TIERNAN PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12204 W SHARON RD
OAKLEY MI
48649-9718
US

IV. Provider business mailing address

12204 W SHARON RD
OAKLEY MI
48649-9718
US

V. Phone/Fax

Practice location:
  • Phone: 517-449-0791
  • Fax:
Mailing address:
  • Phone: 517-449-0791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number4704347762
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: