Provider Demographics
NPI:1003973728
Name:TAYLOR, NINA L (DO)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:L
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 W LINCOLN HWY
Mailing Address - Street 2:NORTHERN ILLINOIS UNIVERSITY / HEALTH SERVICES
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-2828
Mailing Address - Country:US
Mailing Address - Phone:815-753-1311
Mailing Address - Fax:
Practice Address - Street 1:1425 W LINCOLN HWY
Practice Address - Street 2:NORTHERN ILLINOIS UNIVERSITY / HEALTH SERVICES
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-2828
Practice Address - Country:US
Practice Address - Phone:815-753-1311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL336-042152207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL211332OtherMEDICARE ID
ILM 7626Medicare ID - Type Unspecified
ILE 18656Medicare UPIN