Provider Demographics
NPI:1255301727
Name:TAYLOR, ELLEN JANE (ARNP)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:JANE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 W IRONWOOD DR
Mailing Address - Street 2:SUITE 272E
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2656
Mailing Address - Country:US
Mailing Address - Phone:208-676-0102
Mailing Address - Fax:208-676-0147
Practice Address - Street 1:700 W IRONWOOD DR
Practice Address - Street 2:SUITE 170E
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2656
Practice Address - Country:US
Practice Address - Phone:208-667-9110
Practice Address - Fax:208-676-1272
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP467A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805687300Medicaid
ID805687300Medicaid
IDE16226Medicare UPIN