| Doctor Name: | MS. MARYELLEN THERESE KIERNAN |
| NPI Number: | 1013234509 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | R.N. |
| License Number: | 188169 |
| Business Practice Address: | 459 S Broadway Hicksville, NY - 118015023 |
| Business Phone Number: | 5169387568 |
| Business Fax Number: | 5169387097 |
| Mailing Address: | 459 S Broadway, HICKSVILLE |
| State: | NY |
| Postal Code: | 118015023 |
| Phone Number: | 5169387568 |
| Fax Number: | 5169387097 |
| NPI Enumeration Date: | 04/23/2010 |
| NPI Last Update Date: | 04/23/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WP0809X |
| License Number: | 188169 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Psych/Mental Health, Adult |
| Taxonomy Definition: | |