Healthcare Provider Details

I. General information

NPI: 1326066515
Provider Name (Legal Business Name): JOHN MICHAEL TALBOT RNAP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 PLEASANT STREET
NORTHAMPTON MA
01060-1821
US

IV. Provider business mailing address

19 GREEN STREET
GREENFIELD MA
01301-1821
US

V. Phone/Fax

Practice location:
  • Phone: 413-584-6855
  • Fax:
Mailing address:
  • Phone: 413-772-2325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number160353
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberRN160353
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN160353
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: