Provider Demographics
NPI:1578251898
Name:TAYLOR, VICKIE
Entity Type:Individual
Prefix:
First Name:VICKIE
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 1:30810 MIDNIGHT MOON LN
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-1169
Mailing Address - Country:US
Mailing Address - Phone:858-285-5056
Mailing Address - Fax:
Practice Address - Street 1:WALGREENS
Practice Address - Street 2:1574 E VALLEY PKWY
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92027
Practice Address - Country:US
Practice Address - Phone:760-839-7932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN202085164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse