Provider Demographics
NPI:1992016562
Name:TAYLOR, CONNIE NATALIE (MD)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:NATALIE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 UNIVERSITY AVE E
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-2507
Mailing Address - Country:US
Mailing Address - Phone:651-291-2848
Mailing Address - Fax:651-602-6885
Practice Address - Street 1:1417 S. CLIFF AVENUE
Practice Address - Street 2:SUITE 010
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-5710
Practice Address - Country:US
Practice Address - Phone:605-322-7519
Practice Address - Fax:651-602-6885
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD95042084N0402X
MN62796208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology