Provider Demographics
NPI:1689226441
Name:ELISON, TIERNEY KATHLEEN (CNM)
Entity type:Individual
Prefix:MRS
First Name:TIERNEY
Middle Name:KATHLEEN
Last Name:ELISON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 MT AUBURN ST
Mailing Address - Street 2:PARSONS 2
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-5597
Mailing Address - Country:US
Mailing Address - Phone:617-499-5151
Mailing Address - Fax:617-547-0636
Practice Address - Street 1:330 MT AUBURN ST
Practice Address - Street 2:STANTON 1ST FLOOR
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5502
Practice Address - Country:US
Practice Address - Phone:617-499-5151
Practice Address - Fax:617-547-0636
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-11
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICNM00183367A00000X
MARN2318216367A00000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MARN231826OtherMASSACHUSETTS BOARD OF NURSING