Provider Demographics
NPI:1275963928
Name:TAYLOR, CAROL (LPN)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 PEBBLERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:NY
Mailing Address - Zip Code:14103-9563
Mailing Address - Country:US
Mailing Address - Phone:585-297-0911
Mailing Address - Fax:585-395-6002
Practice Address - Street 1:31 PEBBLERIDGE DR
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:NY
Practice Address - Zip Code:14103-9563
Practice Address - Country:US
Practice Address - Phone:585-297-0911
Practice Address - Fax:585-395-6002
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-16
Last Update Date:2013-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175997-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse