Individual
MAYRA JANETTE TALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1330 ROCKEFELLER AVE STE 520, EVERETT, WA 98201-1677
(425) 297-5200
Mailing address
PO BOX 3360, PORTLAND, OR 97208-3360
(425) 297-5200
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA61471449
WA
363AS0400X
Surgical Physician Assistant
PA61471449
WA
Other
Enumeration date
09/07/2022
Last updated
07/02/2024
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