Provider Demographics
NPI:1710492012
Name:TAYLOR, MEGAN LEA
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:LEA
Last Name:TAYLOR
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 1:1902 W B ST
Mailing Address - Street 2:
Mailing Address - City:MC COOK
Mailing Address - State:NE
Mailing Address - Zip Code:69001-3579
Mailing Address - Country:US
Mailing Address - Phone:308-345-7024
Mailing Address - Fax:
Practice Address - Street 1:1902 W B ST
Practice Address - Street 2:
Practice Address - City:MC COOK
Practice Address - State:NE
Practice Address - Zip Code:69001-3579
Practice Address - Country:US
Practice Address - Phone:308-345-7024
Practice Address - Fax:308-345-8039
Is Sole Proprietor?:No
Enumeration Date:2017-12-08
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13141183500000X
NE11423183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE11423OtherNEBRASKA LICENSE #