Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 95011693 | CA |
NPI | 1013573302 |
---|---|
Provider Name | Monika Talley |
First Address | Palmdale, CA 93551-6939 |
Second Address | Redlands, CA 92373-3145 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2019 |
Last Update Date | 13/05/2019 |