Provider Demographics
NPI:1114284759
Name:TAYLOR, LAURA W (PA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:W
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 INDEPENDENCE CIR
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-0258
Mailing Address - Country:US
Mailing Address - Phone:530-899-9038
Mailing Address - Fax:530-899-0142
Practice Address - Street 1:100 INDEPENDENCE CIR
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-0258
Practice Address - Country:US
Practice Address - Phone:530-899-9393
Practice Address - Fax:530-809-2639
Is Sole Proprietor?:No
Enumeration Date:2012-04-20
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53211363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant