Provider Demographics
NPI:1891487021
Name:TALLIER, PEGGY C. CLAIRE (FNP)
Entity type:Individual
Prefix:DR
First Name:PEGGY C.
Middle Name:CLAIRE
Last Name:TALLIER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 E CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-2222
Mailing Address - Country:US
Mailing Address - Phone:917-865-2096
Mailing Address - Fax:
Practice Address - Street 1:559 GRAMATAN AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10552-2155
Practice Address - Country:US
Practice Address - Phone:914-663-0151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY448966163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty