Provider Demographics
NPI:1073051884
Name:TAYLOR, SAMUEL (CRNA)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 LOUISIANA BLVD NE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-7022
Mailing Address - Country:US
Mailing Address - Phone:505-260-4300
Mailing Address - Fax:505-260-4371
Practice Address - Street 1:1720 LOUISIANA BLVD NE
Practice Address - Street 2:SUITE 401
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7022
Practice Address - Country:US
Practice Address - Phone:505-260-4300
Practice Address - Fax:505-260-4371
Is Sole Proprietor?:No
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCRNA-01470367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered