Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 5627 | NE |
Y | 207VX0201X | Gynecologic Oncologist | 27892 | NE |
N | 207VX0201X | Gynecologic Oncologist | 35.097164 | OH |
NPI | 1033316294 |
---|---|
Provider Name | Dr. Brent Jonathan Tierney |
First Address | Virginia Beach, VA 23450-0190 |
Second Address | Omaha, NE 68114-4108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2007 |
Last Update Date | 05/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100250445-00 | (05) | NE |
100264208-00 | (05) | NE |
1033316294 | (05) | IA |