Provider Demographics
NPI:1548206881
Name:TAYLOR, CONNIE LYNN (LAC)
Entity Type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:LYNN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4220 H ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-3425
Mailing Address - Country:US
Mailing Address - Phone:916-452-5170
Mailing Address - Fax:916-452-5171
Practice Address - Street 1:4220 H ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-3425
Practice Address - Country:US
Practice Address - Phone:916-452-5170
Practice Address - Fax:916-452-5171
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC3945171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist