Provider Demographics
NPI:1578202537
Name:TAYLOR, JEANETTA GLENESE (RN)
Entity Type:Individual
Prefix:MRS
First Name:JEANETTA
Middle Name:GLENESE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 LORI DR
Mailing Address - Street 2:
Mailing Address - City:STONEWALL
Mailing Address - State:LA
Mailing Address - Zip Code:71078-9629
Mailing Address - Country:US
Mailing Address - Phone:318-422-7511
Mailing Address - Fax:
Practice Address - Street 1:320 LORI DR
Practice Address - Street 2:
Practice Address - City:STONEWALL
Practice Address - State:LA
Practice Address - Zip Code:71078-9629
Practice Address - Country:US
Practice Address - Phone:318-422-7511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-28
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN147984163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LARN147984OtherRN LICENSE