Provider Demographics
NPI:1376259168
Name:TAYLOR, ASTGIK AMBARTSUMIAN (QMHS-B, RN)
Entity Type:Individual
Prefix:
First Name:ASTGIK
Middle Name:AMBARTSUMIAN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:QMHS-B, RN
Other - Prefix:
Other - First Name:ASTGIK
Other - Middle Name:
Other - Last Name:AMBARTSUMIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23900 COMMERCE PARK
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5822
Mailing Address - Country:US
Mailing Address - Phone:440-753-6030
Mailing Address - Fax:440-232-3801
Practice Address - Street 1:23900 COMMERCE PARK
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5822
Practice Address - Country:US
Practice Address - Phone:440-753-6030
Practice Address - Fax:440-232-3801
Is Sole Proprietor?:No
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.476306163W00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No163W00000XNursing Service ProvidersRegistered Nurse