Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 20A6830 | CA |
NPI | 1396873774 |
---|---|
Provider Name | Dr. Janine Marie Talty |
First Address | Roanoke, VA 24015-4308 |
Second Address | Roanoke, VA 24015-4308 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2007 |
Last Update Date | 16/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0102202736 | MEDICAL LICENSE (01) | VA |