Provider Demographics
NPI:1407185200
Name:TAYLOR, BETH ANN (CST, SA)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:ANN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:CST, SA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 FALCON DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-1930
Mailing Address - Country:US
Mailing Address - Phone:540-371-2724
Mailing Address - Fax:540-735-0266
Practice Address - Street 1:195 FALCON DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-1930
Practice Address - Country:US
Practice Address - Phone:540-371-2724
Practice Address - Fax:540-735-0266
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA111627246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist