Provider Demographics
NPI:1841763208
Name:TAYLOR, COURTNEY ARLENE
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ARLENE
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 1:2 GLEN OAK DR
Mailing Address - Street 2:
Mailing Address - City:LANDENBERG
Mailing Address - State:PA
Mailing Address - Zip Code:19350-1056
Mailing Address - Country:US
Mailing Address - Phone:302-668-9761
Mailing Address - Fax:
Practice Address - Street 1:2 GLEN OAK DR
Practice Address - Street 2:
Practice Address - City:LANDENBERG
Practice Address - State:PA
Practice Address - Zip Code:19350-1056
Practice Address - Country:US
Practice Address - Phone:302-668-9761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN307629164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse