Basic Information
| Provider Information | |||||||||
| NPI: | 1659022713 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TALEB | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 PERIMETER DR APT 2311 | ||||||||
| Address2: | |||||||||
| City: | MIDLOTHIAN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 231137347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1804898522 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10543 S CRATER RD | ||||||||
| Address2: | |||||||||
| City: | SOUTH PRINCE GEORGE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 238057333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008056989 | ||||||||
| FaxNumber: | 8044315820 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2022 | ||||||||
| LastUpdateDate: | 01/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 0002057466 | VA | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.