Provider Demographics
NPI:1578793352
Name:TAYLOR, DENA MARIE (LMP)
Entity Type:Individual
Prefix:
First Name:DENA
Middle Name:MARIE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 W STORY RD
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-7105
Mailing Address - Country:US
Mailing Address - Phone:360-427-7461
Mailing Address - Fax:360-427-7680
Practice Address - Street 1:SE 1061 SR 3
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-9195
Practice Address - Country:US
Practice Address - Phone:360-427-7461
Practice Address - Fax:360-427-7680
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00004948174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist