Provider Demographics
NPI:1831271584
Name:TALLMAN, TERRY (CRNP PEDIATRIC)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:TALLMAN
Suffix:
Gender:F
Credentials:CRNP PEDIATRIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 S PLEASANT AVENUE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501
Mailing Address - Country:US
Mailing Address - Phone:814-445-3575
Mailing Address - Fax:814-445-8039
Practice Address - Street 1:126 EAST CHURCH STREET
Practice Address - Street 2:SUITE 2300
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501
Practice Address - Country:US
Practice Address - Phone:814-443-2888
Practice Address - Fax:814-443-1789
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP003415D363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA862790Medicare ID - Type Unspecified
S21588Medicare UPIN