Provider Demographics
NPI:1306101290
Name:TALBERT, NANCY CHRISTINE
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:CHRISTINE
Last Name:TALBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:
Other - Last Name:TALBERT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8776 KILBOURNE RD
Mailing Address - Street 2:
Mailing Address - City:SUNBURY
Mailing Address - State:OH
Mailing Address - Zip Code:43074-8509
Mailing Address - Country:US
Mailing Address - Phone:740-524-0660
Mailing Address - Fax:
Practice Address - Street 1:8776 KILBOURNE RD
Practice Address - Street 2:
Practice Address - City:SUNBURY
Practice Address - State:OH
Practice Address - Zip Code:43074-8509
Practice Address - Country:US
Practice Address - Phone:740-524-0660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-07
Last Update Date:2012-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BC3200X
OH2011755 - DODD #332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2554632Medicaid