Provider Demographics
NPI:1023850559
Name:SHOWERS, TAYLOR RENEE (CRNP, DNP)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:RENEE
Last Name:SHOWERS
Suffix:
Gender:F
Credentials:CRNP, DNP
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:RENEE
Other - Last Name:DIETRICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP, DNP
Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:21 SUSQUEHANNA VALLEY MALL DR STE A
Practice Address - Street 2:
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870-9148
Practice Address - Country:US
Practice Address - Phone:570-374-7852
Practice Address - Fax:570-374-7932
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-06
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN707186163W00000X
PASP030298363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA6W5238OtherMEDICARE
PA1043765800001Medicaid