Provider Demographics
NPI:1902034861
Name:KLUVER, TIERNIE J (PA)
Entity Type:Individual
Prefix:
First Name:TIERNIE
Middle Name:J
Last Name:KLUVER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:TIERNIE
Other - Middle Name:J
Other - Last Name:SHIPLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:200 VIRGIL AVE SE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IA
Mailing Address - Zip Code:52314-1589
Mailing Address - Country:US
Mailing Address - Phone:319-895-8841
Mailing Address - Fax:319-895-8477
Practice Address - Street 1:200 VIRGIL AVE SE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IA
Practice Address - Zip Code:52314-1589
Practice Address - Country:US
Practice Address - Phone:319-895-8841
Practice Address - Fax:319-895-8477
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02006363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1902034861Medicaid
IA71926083Medicare PIN