Provider Demographics
NPI:1386189637
Name:COUSAR, TALIAH
Entity Type:Individual
Prefix:MS
First Name:TALIAH
Middle Name:
Last Name:COUSAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4580 SEQUOIA DR
Mailing Address - Street 2:B
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-5168
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4580 SEQUOIA DR
Practice Address - Street 2:B
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-5168
Practice Address - Country:US
Practice Address - Phone:347-262-5450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-22
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308671-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse