Provider Demographics
NPI:1235399445
Name:TAYLOR, WENDY JEAN (BS, RN, PHN)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:JEAN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:BS, RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11572 B AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-2605
Mailing Address - Country:US
Mailing Address - Phone:530-889-7191
Mailing Address - Fax:530-886-2945
Practice Address - Street 1:11572 B AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-2605
Practice Address - Country:US
Practice Address - Phone:530-889-7191
Practice Address - Fax:530-886-2945
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA642188163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO52308235Medicaid