Provider Demographics
NPI:1609993997
Name:TAYLOR, LAURA EVELYN (RN,CNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:EVELYN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:RN,CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 PLEASANT DR
Mailing Address - Street 2:
Mailing Address - City:LUCASVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45648-8513
Mailing Address - Country:US
Mailing Address - Phone:740-259-4918
Mailing Address - Fax:740-354-6141
Practice Address - Street 1:411 2ND ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-3806
Practice Address - Country:US
Practice Address - Phone:740-353-3173
Practice Address - Fax:740-354-6141
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCNP03652363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2211707Medicaid
OHP-28871Medicare UPIN