Provider Demographics
NPI:1114793775
Name:TAKESSIAN, TALAR (MSN, AGPCNP-BC)
Entity Type:Individual
Prefix:MISS
First Name:TALAR
Middle Name:
Last Name:TAKESSIAN
Suffix:
Gender:F
Credentials:MSN, AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41721 HANFORD RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-3513
Mailing Address - Country:US
Mailing Address - Phone:734-578-3855
Mailing Address - Fax:
Practice Address - Street 1:41721 HANFORD RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3513
Practice Address - Country:US
Practice Address - Phone:734-578-3855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704339362NSA230JE363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health