Provider Demographics
NPI:1467011510
Name:TAYLOR, AMY (RN, CBS, IBCLC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:RN, CBS, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4176 S PLAZA TRL STE 217
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-1920
Mailing Address - Country:US
Mailing Address - Phone:757-642-4568
Mailing Address - Fax:757-455-8055
Practice Address - Street 1:4176 S PLAZA TRL STE 217
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1920
Practice Address - Country:US
Practice Address - Phone:757-642-4568
Practice Address - Fax:757-455-8055
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001181317163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
Provider Identifiers
StateIdentifier IDID TypeIssuer
L-302768OtherIBCLC