Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | RN199100 | GA |
NPI | 1568007748 |
---|---|
Provider Name | Lauren W Tiernan |
First Address | Augusta, GA 30906-3815 |
Second Address | Augusta, GA 30906-3815 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2019 |
Last Update Date | 12/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000606317B | (05) | GA |