Provider Demographics
NPI:1629550793
Name:TAYLOR, DESIREE E (LVN)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:E
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 CALUMET ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79706-4595
Mailing Address - Country:US
Mailing Address - Phone:931-315-0507
Mailing Address - Fax:
Practice Address - Street 1:906 CALUMET ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79706-4595
Practice Address - Country:US
Practice Address - Phone:931-315-0507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX331969164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse