Healthcare Provider Details

I. General information

NPI: 1962852665
Provider Name (Legal Business Name): DAVID TALLON NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2016
Last Update Date: 06/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 ERWIN RD
DURHAM NC
27705-3941
US

IV. Provider business mailing address

2100 ERWIN RD
DURHAM NC
27705-3941
US

V. Phone/Fax

Practice location:
  • Phone: 919-681-5551
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number5007607
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: