MEDICARE: ELISA ANN TALBOT L.P.N.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	26133-031	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073596482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISA ANN TALBOT L.P.N.

Provider Business Mailing Address
First Line	:	W12345 HWY 16-60
Second Line	:
City	:	COLUMBUS
State	:	WI
Zip	:	53925-8901
Country	:	US
Telephone Number	:	920-623-4938
Fax Number	:

Provider Business Practice Location Address
First Line	:	W12345 HWY 16-60
Second Line	:
City	:	COLUMBUS
State	:	WI
Zip	:	53925-8901
Country	:	US
Telephone Number	:	920-623-4938
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	07/09/2007

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