Provider Demographics
NPI:1841399391
Name:TAYLOR, PATTY J (CNM)
Entity Type:Individual
Prefix:
First Name:PATTY
Middle Name:J
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:PATTY
Other - Middle Name:J
Other - Last Name:BOONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 ELDORADO BLVD # 6250
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-3408
Mailing Address - Country:US
Mailing Address - Phone:303-272-0751
Mailing Address - Fax:303-318-2488
Practice Address - Street 1:1960 OGDEN ST STE 320
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-3669
Practice Address - Country:US
Practice Address - Phone:303-318-2620
Practice Address - Fax:303-318-2629
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO079677363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO64729877Medicaid
CO64729877Medicaid