Healthcare Provider Details

I. General information

NPI: 1447087614
Provider Name (Legal Business Name): TALICE STANTON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TALICE A NIETO TALICE A NIETO

II. Dates (important events)

Enumeration Date: 09/19/2024
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9939 STATE HIGHWAY 151
SAN ANTONIO TX
78251-1900
US

IV. Provider business mailing address

9939 STATE HIGHWAY 151
SAN ANTONIO TX
78251-1900
US

V. Phone/Fax

Practice location:
  • Phone: 210-706-7891
  • Fax: 210-443-0333
Mailing address:
  • Phone: 210-706-7891
  • Fax: 210-443-0333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1023471
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: