Healthcare Provider Details

I. General information

NPI: 1992973747
Provider Name (Legal Business Name): ALLISON W TALLEY MSNCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 W LANE AVE SUITE D
COLUMBUS OH
43221-3538
US

IV. Provider business mailing address

1315 W LANE AVE SUITE D
COLUMBUS OH
43221-3538
US

V. Phone/Fax

Practice location:
  • Phone: 614-457-4827
  • Fax: 614-457-9733
Mailing address:
  • Phone: 614-457-4827
  • Fax: 614-457-9733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number08028
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number285209
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: