Provider Demographics
NPI:1497527113
Name:TAYLOR, MARINA LARK (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:LARK
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:RN, IBCLC
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 2467
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85372-2467
Mailing Address - Country:US
Mailing Address - Phone:623-241-1659
Mailing Address - Fax:
Practice Address - Street 1:16221 N 91ST DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-3545
Practice Address - Country:US
Practice Address - Phone:623-241-1659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN140879163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant