Provider Demographics
NPI:1780977413
Name:TALLEY GIEDT, EVELYN (EVA) DENISE (PMH NP)
Entity type:Individual
Prefix:MRS
First Name:EVELYN (EVA)
Middle Name:DENISE
Last Name:TALLEY GIEDT
Suffix:
Gender:M
Credentials:PMH NP
Other - Prefix:MRS
Other - First Name:EVA
Other - Middle Name:
Other - Last Name:GIEDT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PMH NP
Mailing Address - Street 1:183 SARGENT CT
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-3115
Mailing Address - Country:US
Mailing Address - Phone:831-236-7110
Mailing Address - Fax:831-484-1348
Practice Address - Street 1:183 SARGENT CT
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-3115
Practice Address - Country:US
Practice Address - Phone:831-236-7110
Practice Address - Fax:831-484-1348
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-27
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 20661363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health