Provider Demographics
NPI:1740779578
Name:TAYLOR, RICHARD MICHAEL (LPN)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:MICHAEL
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:MR
Other - First Name:RICHARD
Other - Middle Name:
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:18617 40TH AVE W
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-7612
Mailing Address - Country:US
Mailing Address - Phone:206-495-3431
Mailing Address - Fax:
Practice Address - Street 1:13531 JUAN WOOD WAY NE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-5225
Practice Address - Country:US
Practice Address - Phone:425-279-7151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP00055339164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse