Provider Demographics
NPI:1598748642
Name:TAYLOR, COLLEEN (FPNP)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:FPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 587
Mailing Address - Street 2:43 GABRIEL DR
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04332-0587
Mailing Address - Country:US
Mailing Address - Phone:207-622-7524
Mailing Address - Fax:207-621-8393
Practice Address - Street 1:97 WATER ST
Practice Address - Street 2:RM 204
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-6339
Practice Address - Country:US
Practice Address - Phone:207-859-1639
Practice Address - Fax:207-859-1696
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER013536163WR1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR1000XNursing Service ProvidersRegistered NurseReproductive Endocrinology/Infertility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME999001008Medicaid