Individual
MRS. DANIELLE BEA TALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA60106229
Contact information
Practice address
200 BETHEL AVE, PORT ORCHARD, WA 98366-5216
(360) 876-4171
(360) 876-3495
Mailing address
200 BETHEL AVE, PORT ORCHARD, WA 98366-5216
(360) 876-4171
(360) 876-3495
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA60106229
WA
Other
Enumeration date
10/05/2009
Last updated
10/05/2009
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