Provider Demographics
NPI:1447087614
Name:STANTON, TALICE (RN)
Entity type:Individual
Prefix:MRS
First Name:TALICE
Middle Name:
Last Name:STANTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:TALICE
Other - Middle Name:A
Other - Last Name:NIETO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:TALICE A NIETO
Mailing Address - Street 1:9939 STATE HIGHWAY 151
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-1900
Mailing Address - Country:US
Mailing Address - Phone:210-706-7891
Mailing Address - Fax:210-443-0333
Practice Address - Street 1:9939 STATE HIGHWAY 151
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-1900
Practice Address - Country:US
Practice Address - Phone:210-706-7891
Practice Address - Fax:210-443-0333
Is Sole Proprietor?:No
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1023471163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC236Medicaid