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NPI Code Detail

MEDICARE: CRYSTAL ANN TALAVERA WHCNP

MEDICARE: CRYSTAL ANN TALAVERA WHCNP
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
1363LW0102XWomen's Health Nurse PractitionerAP116902TX

General Provider Information

NPI Number : 1154510980
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRYSTAL ANN TALAVERA WHCNP
Provider Business Mailing Address
First Line : PO BOX 632040
Second Line :
City : NACOGDOCHES
State : TX
Zip : 75963-2040
Country : US
Telephone Number : 936-585-7121
Fax Number :
Provider Business Practice Location Address
First Line : 1309 S UNIVERSITY DR
Second Line :
City : NACOGDOCHES
State : TX
Zip : 75961-6486
Country : US
Telephone Number : 936-560-5668
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2007
Last Update Date : 06/13/2024

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