Healthcare Provider Details

I. General information

NPI: 1154817856
Provider Name (Legal Business Name): HEAVEN L TIERNEY APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEAVEN FLEMMING

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2925 CHICAGO AVE
MINNEAPOLIS MN
55407-1321
US

IV. Provider business mailing address

4913 WESTLUND RD
SAGINAW MN
55779-9781
US

V. Phone/Fax

Practice location:
  • Phone: 218-830-8000
  • Fax:
Mailing address:
  • Phone: 218-830-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2078221
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5997
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: