Provider Demographics
NPI:1265078026
Name:TALICH, TERRI LYNN (RN, CMSRN)
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:LYNN
Last Name:TALICH
Suffix:
Gender:F
Credentials:RN, CMSRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 FRONT ST S
Mailing Address - Street 2:E102
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-4251
Mailing Address - Country:US
Mailing Address - Phone:509-876-6618
Mailing Address - Fax:
Practice Address - Street 1:700 FRONT ST S
Practice Address - Street 2:E102
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-4251
Practice Address - Country:US
Practice Address - Phone:509-876-6618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-26
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60559009163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-SurgicalGroup - Single Specialty