Provider Demographics
NPI:1821855446
Name:TAYLOR, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
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 1:15262 BROKEN TOP AVE
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:OR
Mailing Address - Zip Code:97055-7877
Mailing Address - Country:US
Mailing Address - Phone:503-313-4707
Mailing Address - Fax:
Practice Address - Street 1:26775 SE KELSO RD
Practice Address - Street 2:
Practice Address - City:BORING
Practice Address - State:OR
Practice Address - Zip Code:97009-6000
Practice Address - Country:US
Practice Address - Phone:503-512-9055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator