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NPI Code Detail

MEDICARE: MS. NICHELEI ANISSA TALMORE MA CCCA

MEDICARE: MS. NICHELEI ANISSA TALMORE MA CCCA
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
1237600000XAudiologist-Hearing Aid FitterAUD003741GA
2231H00000XAudiologistAUD003741GA
3231H00000XAudiologist80613TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
164BCBPTOTHERGAMEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1679507610
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. NICHELEI ANISSA TALMORE MA CCCA
Provider Business Mailing Address
First Line : 4001 HIGHWAY 36 S
Second Line :
City : BRENHAM
State : TX
Zip : 77833-9610
Country : US
Telephone Number : 979-836-4511
Fax Number :
Provider Business Practice Location Address
First Line : 4001 HIGHWAY 36 S
Second Line :
City : BRENHAM
State : TX
Zip : 77833-9610
Country : US
Telephone Number : 979-836-4511
Fax Number : 979-277-1865
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2006
Last Update Date : 01/13/2016

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