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General NPI Number Information
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NPI Number | 1508195215
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Entity Type | Individual
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Provider Name | TIERNEY MARIE O'CONNELL CRNA
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Gender | Female
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Dates
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Enumeration Date | 12/09/2009
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Last Update Date | 12/14/2009
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Provider Practice Location Address
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Address Line | 201 E UNIVERSITY PKWY 33RD ST. PROF. BLDG., SUITE 226
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City | BALTIMORE
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State | MD
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Zip | 21218-2829
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Country | US
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Telephone | 410-299-2692
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Fax |
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Provider Business Mailing Address
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Address Line | 936 STORMONT CIR
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City | HALETHORPE
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State | MD
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Zip | 21227-3815
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Country | US
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Telephone | 410-299-2692
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | R170671
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License Number State | MD
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