Provider Demographics
NPI:1699870360
Name:CROMWELL, TALIA NICOLE (CNP)
Entity type:Individual
Prefix:MRS
First Name:TALIA
Middle Name:NICOLE
Last Name:CROMWELL
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MISS
Other - First Name:TALIA
Other - Middle Name:NICOLE
Other - Last Name:BRADER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:8624 OAK CREEK DR
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-8994
Mailing Address - Country:US
Mailing Address - Phone:740-549-6506
Mailing Address - Fax:740-994-8455
Practice Address - Street 1:44 S KINTNER PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:SUNBURY
Practice Address - State:OH
Practice Address - Zip Code:43074-9368
Practice Address - Country:US
Practice Address - Phone:740-965-4362
Practice Address - Fax:740-994-8455
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN311014363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHQ75844Medicare UPIN
OHCRNP22921Medicare PIN