Provider Demographics
NPI:1134313760
Name:TAYLOR, MARY E (C-NP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:E
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:C-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8256 CEDAR LANDING CT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-3237
Mailing Address - Country:US
Mailing Address - Phone:703-201-4263
Mailing Address - Fax:
Practice Address - Street 1:700 CONSTITUTION AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-6058
Practice Address - Country:US
Practice Address - Phone:202-543-4800
Practice Address - Fax:202-675-0411
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
DCRN53170363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P51262Medicare UPIN