Provider Demographics
NPI:1275296774
Name:DOUDAKLIAN, TALINE (RN)
Entity Type:Individual
Prefix:
First Name:TALINE
Middle Name:
Last Name:DOUDAKLIAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6164 RIDGE AVE APT 301
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-2628
Mailing Address - Country:US
Mailing Address - Phone:215-520-3949
Mailing Address - Fax:
Practice Address - Street 1:1040 N AMERICAN ST UNIT 1101
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-1568
Practice Address - Country:US
Practice Address - Phone:267-586-4978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN749460163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse