Provider Demographics
NPI:1063043768
Name:TAYLOR, LORETTA JOANN (NURSE)
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:JOANN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:LORETTA
Other - Middle Name:JOANN
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE
Mailing Address - Street 1:611 E CAWSON ST # A
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:23860-3015
Mailing Address - Country:US
Mailing Address - Phone:804-295-7064
Mailing Address - Fax:
Practice Address - Street 1:611 E CAWSON ST # A
Practice Address - Street 2:
Practice Address - City:HOPEWELL
Practice Address - State:VA
Practice Address - Zip Code:23860-3015
Practice Address - Country:US
Practice Address - Phone:804-295-7064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-31
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002066574164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse