Provider Demographics
NPI:1053504647
Name:TAYLOR, VALERIE EVADNE (LVN)
Entity Type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:EVADNE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4611 W MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:APARTMENT 197
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90016-5556
Mailing Address - Country:US
Mailing Address - Phone:323-296-0249
Mailing Address - Fax:
Practice Address - Street 1:4611 W MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:APARTMENT 197
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90016-5556
Practice Address - Country:US
Practice Address - Phone:323-296-0249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN215688164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse