Provider Demographics
NPI:1013573302
Name:TALLEY, MONIKA (FNP-C)
Entity Type:Individual
Prefix:
First Name:MONIKA
Middle Name:
Last Name:TALLEY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2427 BROMPTON CT
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-6939
Mailing Address - Country:US
Mailing Address - Phone:818-245-0078
Mailing Address - Fax:
Practice Address - Street 1:1855 W REDLANDS BLVD FL 2
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-3145
Practice Address - Country:US
Practice Address - Phone:909-890-0407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-13
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95011693363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care