Provider Demographics
NPI:1235742834
Name:TAYLOR, NICOLE M (STNA)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:M
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:899 CHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44314-2807
Mailing Address - Country:US
Mailing Address - Phone:330-328-9025
Mailing Address - Fax:
Practice Address - Street 1:899 CHESTER AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44314-2807
Practice Address - Country:US
Practice Address - Phone:330-328-9025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401843590416251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH401843590416OtherSTNA REGISTRY