Provider Demographics
NPI:1407063613
Name:TAYLOR, MARGO ELLEN (LPN)
Entity Type:Individual
Prefix:MS
First Name:MARGO
Middle Name:ELLEN
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 1:2 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:13668-3100
Mailing Address - Country:US
Mailing Address - Phone:315-353-9930
Mailing Address - Fax:315-353-9930
Practice Address - Street 1:2 WALNUT ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:NY
Practice Address - Zip Code:13668-3100
Practice Address - Country:US
Practice Address - Phone:315-353-9930
Practice Address - Fax:315-353-9930
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY249323-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02365373Medicaid