Provider Demographics
NPI:1629490685
Name:TALBERT, TREVA VERONICA (RN, CCM)
Entity Type:Individual
Prefix:MS
First Name:TREVA
Middle Name:VERONICA
Last Name:TALBERT
Suffix:
Gender:F
Credentials:RN, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3761 HERITAGE PKWY
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3184
Mailing Address - Country:US
Mailing Address - Phone:313-670-5734
Mailing Address - Fax:
Practice Address - Street 1:26957 NORTHWESTERN HWY
Practice Address - Street 2:SUITE #400
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-4700
Practice Address - Country:US
Practice Address - Phone:855-465-0345
Practice Address - Fax:248-331-4245
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-10
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704257634163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse