Provider Demographics
NPI:1518372648
Name:MARVIENNE TALLEY
Entity Type:Organization
Organization Name:MARVIENNE TALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:
Authorized Official - First Name:MARVIENNE
Authorized Official - Middle Name:SHAWNTE
Authorized Official - Last Name:TALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:121-623-5292
Mailing Address - Street 1:10306 RUSSELL AVE
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-1619
Mailing Address - Country:US
Mailing Address - Phone:216-235-2922
Mailing Address - Fax:
Practice Address - Street 1:10306 RUSSELL AVE
Practice Address - Street 2:
Practice Address - City:GARFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44125-1619
Practice Address - Country:US
Practice Address - Phone:216-235-2922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-27
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health