Provider Demographics
NPI:1659824209
Name:PUDDISTER, TAYLOR CHRISTINE
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:CHRISTINE
Last Name:PUDDISTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 DOLPHIN RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-1305
Mailing Address - Country:US
Mailing Address - Phone:617-290-4245
Mailing Address - Fax:
Practice Address - Street 1:145 WARD HILL AVE
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01835-6928
Practice Address - Country:US
Practice Address - Phone:978-372-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-01
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH068379-21163W00000X
MARN2288813163W00000X, 363LA2100X, 363L00000X
NH068379-23363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care