Provider Demographics
NPI:1013353408
Name:TAYLOR, MARIE MULDOON (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:MULDOON
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:MARIE
Other - Middle Name:MULDOON
Other - Last Name:STUEMKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3650 PIPER ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4692
Mailing Address - Country:US
Mailing Address - Phone:907-222-4624
Mailing Address - Fax:
Practice Address - Street 1:3650 PIPER ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4692
Practice Address - Country:US
Practice Address - Phone:907-222-4624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-13
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1113363AS0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical