Provider Demographics
NPI:1790885929
Name:TAYLOR, DEBRA (PA)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 S 70TH ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-4278
Mailing Address - Country:US
Mailing Address - Phone:402-486-4035
Mailing Address - Fax:402-486-3528
Practice Address - Street 1:1101 S 70TH ST
Practice Address - Street 2:SUITE 203
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-4278
Practice Address - Country:US
Practice Address - Phone:402-486-4035
Practice Address - Fax:402-486-3528
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE161363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEE09153Medicare UPIN