Provider Demographics
NPI:1578899068
Name:TAYLOR, VANESSA RENEE
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:RENEE
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 1:6925 216TH ST SW STE P
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-7358
Mailing Address - Country:US
Mailing Address - Phone:503-657-8663
Mailing Address - Fax:
Practice Address - Street 1:6925 216TH ST SW STE P
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-7358
Practice Address - Country:US
Practice Address - Phone:503-657-8663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-19
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WATAYLOVR160RG2471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography