Provider Demographics
NPI:1649245010
Name:THALLMAN, CHRISTY MARIE (MSN RN FNP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTY
Middle Name:MARIE
Last Name:THALLMAN
Suffix:
Gender:F
Credentials:MSN RN FNP
Other - Prefix:
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Mailing Address - Street 1:36123 SCHOOLCRAFT RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-1216
Mailing Address - Country:US
Mailing Address - Phone:734-464-0887
Mailing Address - Fax:734-402-0254
Practice Address - Street 1:1200 N TELEGRAPH RD
Practice Address - Street 2:BLDG. 32E
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-1032
Practice Address - Country:US
Practice Address - Phone:734-464-0887
Practice Address - Fax:734-402-0254
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704203244363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N82760002OtherMEDICARE
MI0N82770003OtherMEDICARE
MI500F318890OtherBCBS