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General NPI Number Information
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NPI Number | 1831553023
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Entity Type | Individual
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Provider Name | TIERNEY BRENNAN
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Gender | Female
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Dates
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Enumeration Date | 04/13/2016
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Last Update Date | 04/13/2016
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Provider Practice Location Address
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Address Line | 464 INVERARAY RD
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City | VILLANOVA
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State | PA
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Zip | 19085-1138
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Country | US
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Telephone | 630-640-1167
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Fax |
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Provider Business Mailing Address
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Address Line | 464 INVERARAY RD
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City | VILLANOVA
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State | PA
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Zip | 19085-1138
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Country | US
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Telephone | 630-640-1167
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | SP016028
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 209014087
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License Number State | IL
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