Provider Demographics
NPI:1962224642
Name:TALLEY, CHAVAWNA LEE
Entity type:Individual
Prefix:
First Name:CHAVAWNA
Middle Name:LEE
Last Name:TALLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHAVAWNA
Other - Middle Name:LEE
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23405 W FERNHURST DR APT 1607
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-0241
Mailing Address - Country:US
Mailing Address - Phone:346-583-3033
Mailing Address - Fax:
Practice Address - Street 1:23405 W FERNHURST DR APT 1607
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-0241
Practice Address - Country:US
Practice Address - Phone:346-583-3033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy