Provider Demographics
NPI:1942850920
Name:TAYLOR, CONNIE J
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:J
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:JO
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HINTZ, HAMEL, TODD
Mailing Address - Street 1:740 TURNER ST # 30740
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-2756
Mailing Address - Country:US
Mailing Address - Phone:406-546-3737
Mailing Address - Fax:
Practice Address - Street 1:1620 MILWAUKEE WAY APT 101
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-3024
Practice Address - Country:US
Practice Address - Phone:406-214-5056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide