Individual
MISS TALESA MARIE CHARTRAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD, STUDENT DOCTOR
Contact information
Practice address
6650 THURSTON RD, SPRINGFIELD, OR 97478-7154
(541) 321-8622
Mailing address
6650 THURSTON RD, SPRINGFIELD, OR 97478-7154
(541) 321-8622
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
458425
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10-5LL-18803
LICENSE NUMBER
FL
Enumeration date
05/23/2021
Last updated
05/23/2021
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