Provider Demographics
NPI:1457994717
Name:TALITHA CUMI
Entity type:Organization
Organization Name:TALITHA CUMI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-866-4855
Mailing Address - Street 1:6239 WEST BOEHLKE AVENUE
Mailing Address - Street 2:TIANA M. JENKINS
Mailing Address - City:MLWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223
Mailing Address - Country:US
Mailing Address - Phone:800-866-4855
Mailing Address - Fax:
Practice Address - Street 1:6239 WEST BOEHLKE AVENUE
Practice Address - Street 2:TIANA M. JENKINS
Practice Address - City:MLWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223
Practice Address - Country:US
Practice Address - Phone:800-866-4855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744R1103XOther Service ProvidersSpecialistResearch Data Abstracter/CoderGroup - Single Specialty