Provider Demographics
NPI:1831393479
Name:TALOTTA, LOIS N (LMP)
Entity type:Individual
Prefix:
First Name:LOIS
Middle Name:N
Last Name:TALOTTA
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 ELLINOR AVE
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-3218
Mailing Address - Country:US
Mailing Address - Phone:360-427-5898
Mailing Address - Fax:
Practice Address - Street 1:1240 RUDDELL RD SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-5753
Practice Address - Country:US
Practice Address - Phone:360-491-1232
Practice Address - Fax:360-491-1494
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00008646174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0215737OtherL & I PROVIDER #