Provider Demographics
NPI:1811240807
Name:TALLA, JEAN NOEL (HHA)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:NOEL
Last Name:TALLA
Suffix:
Gender:M
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 HAMPSHIRE WEST CT APT 2
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20903-2517
Mailing Address - Country:US
Mailing Address - Phone:202-706-0514
Mailing Address - Fax:
Practice Address - Street 1:1404 HAMPSHIRE WEST CT APT 2
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-2517
Practice Address - Country:US
Practice Address - Phone:202-706-0514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide