Provider Demographics
NPI:1609398858
Name:TAYLOR, CHRISTINE LEE (NP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:LEE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9660 E 146TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-3095
Mailing Address - Country:US
Mailing Address - Phone:317-774-1221
Mailing Address - Fax:
Practice Address - Street 1:9660 E 146TH ST STE 300
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-3095
Practice Address - Country:US
Practice Address - Phone:317-774-1221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-10
Last Update Date:2017-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71007225B363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AG03170076OtherAANP CERTIFICATION
FL2361957OtherARNP CONTROL NUMBER
IN71007225OtherNP LICENCE
IN28084155OtherRN LICENSE
FL9456170OtherARNP LICENSE