Healthcare Provider Details

I. General information

NPI: 1104024553
Provider Name (Legal Business Name): MELANIE TALLEY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WOLFE ST HALSTED 600, SURGICAL NURSING
BALTIMORE MD
21287-0005
US

IV. Provider business mailing address

1247 BATTERY AVE
BALTIMORE MD
21230-4301
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-5353
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR163636
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: