Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 4301053281 | MI |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | ME120659 | FL |
NPI | 1588697882 |
---|---|
Provider Name | Colleen Cheri Tallen |
First Address | Grand Rapids, MI 49503-2560 |
Second Address | Grand Rapids, MI 49503-2563 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2006 |
Last Update Date | 03/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E49532 | (02) | MI |
HW706Z | (02) | FL |