Provider Demographics
NPI:1225520554
Name:WILBUR, TEYLOR (ARNP, FNP)
Entity Type:Individual
Prefix:
First Name:TEYLOR
Middle Name:
Last Name:WILBUR
Suffix:
Gender:F
Credentials:ARNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9575 ETHAN WADE WAY SE
Mailing Address - Street 2:
Mailing Address - City:SNOQUALMIE
Mailing Address - State:WA
Mailing Address - Zip Code:98065-9577
Mailing Address - Country:US
Mailing Address - Phone:425-888-5511
Mailing Address - Fax:425-888-5513
Practice Address - Street 1:9575 ETHAN WADE WAY SE
Practice Address - Street 2:
Practice Address - City:SNOQUALMIE
Practice Address - State:WA
Practice Address - Zip Code:98065-9577
Practice Address - Country:US
Practice Address - Phone:425-888-5511
Practice Address - Fax:425-888-5513
Is Sole Proprietor?:No
Enumeration Date:2018-06-01
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60765561163W00000X
WAAP60877595363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse