Provider Demographics
NPI:1225396492
Name:TAYLOR, MARY F (MS, RD, CDE, LD)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:F
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MS, RD, CDE, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 2ND ST NE
Mailing Address - Street 2:
Mailing Address - City:NEW PRAGUE
Mailing Address - State:MN
Mailing Address - Zip Code:56071
Mailing Address - Country:US
Mailing Address - Phone:952-758-8136
Mailing Address - Fax:952-758-8146
Practice Address - Street 1:301 2ND ST NE
Practice Address - Street 2:
Practice Address - City:NEW PRAGUE
Practice Address - State:MN
Practice Address - Zip Code:56071
Practice Address - Country:US
Practice Address - Phone:952-758-8136
Practice Address - Fax:952-758-8146
Is Sole Proprietor?:No
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
00451665133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered