1821654021 NPI number — BREE'AN VINIQUE TALBERT AS, BS

Table of content: BREE'AN VINIQUE TALBERT AS, BS (NPI 1821654021)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821654021 NPI number — BREE'AN VINIQUE TALBERT AS, BS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TALBERT
Provider First Name:
BREE'AN
Provider Middle Name:
VINIQUE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AS, BS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821654021
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1320 N MORRISON BLVD STE 106
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMMOND
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70401-2242
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-551-5155
Provider Business Mailing Address Fax Number:
985-551-5222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4201 N I 10 SERVICE RD W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
METAIRIE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70006-6713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-880-9270
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/13/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106S00000X , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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