Provider Demographics
NPI:1992558118
Name:THALL, BIANCA ELISE COLLOP (DOULA)
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:ELISE COLLOP
Last Name:THALL
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:677 EVERGLADE AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-5704
Mailing Address - Country:US
Mailing Address - Phone:707-758-5638
Mailing Address - Fax:
Practice Address - Street 1:677 EVERGLADE AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93619-5704
Practice Address - Country:US
Practice Address - Phone:707-758-5638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula