Provider Demographics
NPI:1952084030
Name:TALLIEU, ANDREA MUELLER (LVN)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MUELLER
Last Name:TALLIEU
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 BERRYESSA PASS
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78732-1264
Mailing Address - Country:US
Mailing Address - Phone:585-643-0005
Mailing Address - Fax:
Practice Address - Street 1:220 BERRYESSA PASS
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78732-1264
Practice Address - Country:US
Practice Address - Phone:585-643-0005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1128253164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse