Provider Demographics
NPI:1497364913
Name:TAYLOR, RENEE
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 274
Mailing Address - Street 2:
Mailing Address - City:DAILEY
Mailing Address - State:WV
Mailing Address - Zip Code:26259-0274
Mailing Address - Country:US
Mailing Address - Phone:304-940-3454
Mailing Address - Fax:
Practice Address - Street 1:LOT 12 VALLEY VIEW MHP
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241
Practice Address - Country:US
Practice Address - Phone:304-636-5195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant