Provider Demographics
NPI:1811191117
Name:TAYLOR, JEANELLE LUCILLE (RN)
Entity Type:Individual
Prefix:MRS
First Name:JEANELLE
Middle Name:LUCILLE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 YALE ST
Mailing Address - Street 2:
Mailing Address - City:GROVELAND
Mailing Address - State:MA
Mailing Address - Zip Code:01834-1558
Mailing Address - Country:US
Mailing Address - Phone:978-374-2533
Mailing Address - Fax:617-783-0255
Practice Address - Street 1:747 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2926
Practice Address - Country:US
Practice Address - Phone:800-833-1220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA226622163WN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0300XNursing Service ProvidersRegistered NurseNephrology