Provider Demographics
NPI:1689332728
Name:TAYLOR-DOUGLAS, WANDA KAY
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:KAY
Last Name:TAYLOR-DOUGLAS
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 1:2 WALDEN MAPLE CT
Mailing Address - Street 2:
Mailing Address - City:GWYNN OAK
Mailing Address - State:MD
Mailing Address - Zip Code:21207-3963
Mailing Address - Country:US
Mailing Address - Phone:443-904-7305
Mailing Address - Fax:
Practice Address - Street 1:4020 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-4225
Practice Address - Country:US
Practice Address - Phone:410-290-1054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR097733163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical