Individual
MRS. MOYA TARA TALLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
25140 AUSTIN DR, NEW BOSTON, MI 48164-8907
(313) 461-5780
Mailing address
25140 AUSTIN DR, NEW BOSTON, MI 48164-8907
(313) 461-5780
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704327517
MI
Other
Enumeration date
05/21/2016
Last updated
08/19/2020
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