MEDICARE: TERRI LYNN TELLIGMAN R.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	163WP0808X	Psychiatric/Mental Health Registered Nurse	RN422016	CA

General Provider Information

NPI Number	:	1487879771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRI LYNN TELLIGMAN R.N.

Provider Business Mailing Address
First Line	:	9747 GOTHIC AVE
Second Line	:
City	:	NORTH HILLS
State	:	CA
Zip	:	91343-1812
Country	:	US
Telephone Number	:	818-895-6183
Fax Number	:

Provider Business Practice Location Address
First Line	:	9747 GOTHIC AVE
Second Line	:
City	:	NORTH HILLS
State	:	CA
Zip	:	91343-1812
Country	:	US
Telephone Number	:	818-895-6183
Fax Number	:

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

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	07/08/2007

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