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Individual

MRS. ANNA MARIE TARAVELLA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.S.

Contact information

Practice address
1701 E COLLEGE AVE, BLOOMINGTON, IL 61704-2101
(309) 664-3010
Mailing address
1701 E COLLEGE AVE, BLOOMINGTON, IL 61704-2101
(309) 664-3010

Taxonomy

Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
147.000942
IL
237600000X
Audiologist-Hearing Aid Fitter
147.000942
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
IL2613
MEDICARE GROUP PTAN
IL
Enumeration date
09/27/2006
Last updated
11/25/2009
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