Provider Demographics
NPI:1558383323
Name:TAYLOR, JANE E (PAC)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:E
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MS
Other - First Name:JANE
Other - Middle Name:ELIZABETH
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:PO BOX 969
Mailing Address - Street 2:
Mailing Address - City:THOMPSON FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59873-0969
Mailing Address - Country:US
Mailing Address - Phone:406-827-4307
Mailing Address - Fax:406-827-9514
Practice Address - Street 1:907 MAIN ST
Practice Address - Street 2:
Practice Address - City:THOMPSON FALLS
Practice Address - State:MT
Practice Address - Zip Code:59873
Practice Address - Country:US
Practice Address - Phone:406-827-4307
Practice Address - Fax:406-827-9514
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT439363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT4307316Medicaid
MT000096973OtherBC & BS
MT000096973OtherBC & BS
000085095Medicare ID - Type Unspecified