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NPI Code Detail

MEDICARE: MRS. DANIELLE BEA TALLEY MA60106229

MEDICARE: MRS. DANIELLE BEA TALLEY MA60106229
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
1174400000XSpecialistMA60106229WA

General Provider Information

NPI Number : 1679808943
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DANIELLE BEA TALLEY MA60106229
Provider Business Mailing Address
First Line : 200 BETHEL AVE
Second Line :
City : PORT ORCHARD
State : WA
Zip : 98366-5216
Country : US
Telephone Number : 360-876-4171
Fax Number : 360-876-3495
Provider Business Practice Location Address
First Line : 200 BETHEL AVE
Second Line :
City : PORT ORCHARD
State : WA
Zip : 98366-5216
Country : US
Telephone Number : 360-876-4171
Fax Number : 360-876-3495
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2009
Last Update Date : 10/05/2009

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