Provider Demographics
NPI:1770637449
Name:HACKER-TAYLOR, MARY DIANNA (RN ARNP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:DIANNA
Last Name:HACKER-TAYLOR
Suffix:
Gender:F
Credentials:RN ARNP
Other - Prefix:MRS
Other - First Name:M.
Other - Middle Name:DIANNA
Other - Last Name:HACKER-TAYLOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN ARNP
Mailing Address - Street 1:204 PATRICK AVE
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:OH
Mailing Address - Zip Code:43078-2302
Mailing Address - Country:US
Mailing Address - Phone:937-484-6157
Mailing Address - Fax:937-484-6181
Practice Address - Street 1:204 PATRICK AVE
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078-2302
Practice Address - Country:US
Practice Address - Phone:937-484-6157
Practice Address - Fax:937-484-6181
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5066P363LP0200X
KY3005066363LF0000X
OHNP.04945363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0162513Medicaid
OHH447350Medicare PIN