Organization
MTT FNP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MOYA TARA TALLEY FNP (ADMIN)
(313) 461-5780
Entity
Organization
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
—
—
Other
Enumeration date
01/07/2021
Last updated
01/07/2021
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