Healthcare Provider Details

I. General information

NPI: 1427965441
Provider Name (Legal Business Name): PATIENT JALLAYU TARLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6704 GABLES WAY
JOHNSTON IA
50131-3025
US

IV. Provider business mailing address

6704 GABLES WAY
JOHNSTON IA
50131-3025
US

V. Phone/Fax

Practice location:
  • Phone: 515-718-3204
  • Fax:
Mailing address:
  • Phone: 515-718-3204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: