Provider Demographics
NPI:1164712402
Name:TAYLOR, CYNTHIA KIM (LPN)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:KIM
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6755 N 83RD AVE APT 1204
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85303-2712
Mailing Address - Country:US
Mailing Address - Phone:623-336-9183
Mailing Address - Fax:
Practice Address - Street 1:15778 W YUMA RD
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-3358
Practice Address - Country:US
Practice Address - Phone:623-932-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP041089164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse