Provider Demographics
NPI:1629409453
Name:TAYLOR, TYLER DAUNE (LPN)
Entity Type:Individual
Prefix:MR
First Name:TYLER
Middle Name:DAUNE
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4578 TEALTOWN RD
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-1025
Mailing Address - Country:US
Mailing Address - Phone:513-477-7380
Mailing Address - Fax:
Practice Address - Street 1:4578 TEALTOWN RD
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103-1025
Practice Address - Country:US
Practice Address - Phone:513-477-7380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-04
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.052345164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse