Provider Demographics
NPI:1093854572
Name:TAYLOR, THERESE M (CRNP)
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:M
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 STATE STREET,
Mailing Address - Street 2:SUITE 16 LL REGIONAL HEALTH SERVICES, INC
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501-1360
Mailing Address - Country:US
Mailing Address - Phone:814-480-7100
Mailing Address - Fax:814-480-7604
Practice Address - Street 1:104 EAST 2ND STREET
Practice Address - Street 2:HAMOT BARIATRIC SURGERY CENTER
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507
Practice Address - Country:US
Practice Address - Phone:814-877-6997
Practice Address - Fax:814-877-6356
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN502657L163WX0200X
PATP007043B163WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0200XNursing Service ProvidersRegistered NurseOncology