Provider Demographics
NPI:1942571815
Name:TIERNEY, MARJORIE COOK (RN)
Entity type:Individual
Prefix:MRS
First Name:MARJORIE
Middle Name:COOK
Last Name:TIERNEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CALKINS PL
Mailing Address - Street 2:
Mailing Address - City:TICONDEROGA
Mailing Address - State:NY
Mailing Address - Zip Code:12883-1510
Mailing Address - Country:US
Mailing Address - Phone:518-585-7400
Mailing Address - Fax:518-585-4076
Practice Address - Street 1:5 CALKINS PL
Practice Address - Street 2:
Practice Address - City:TICONDEROGA
Practice Address - State:NY
Practice Address - Zip Code:12883-1510
Practice Address - Country:US
Practice Address - Phone:518-585-7400
Practice Address - Fax:518-585-4076
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY389492403163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool