Provider Demographics
NPI:1922407758
Name:TALLER, ANNA (NP)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:TALLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ANYA
Other - Middle Name:
Other - Last Name:TALLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:336 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-6355
Mailing Address - Country:US
Mailing Address - Phone:508-872-2002
Mailing Address - Fax:508-872-2922
Practice Address - Street 1:336 UNION AVE
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-6355
Practice Address - Country:US
Practice Address - Phone:508-872-2002
Practice Address - Fax:508-872-2922
Is Sole Proprietor?:No
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2277194363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology