Provider Demographics
NPI:1134788409
Name:DOW, NIKKI-TAYLOR
Entity type:Individual
Prefix:
First Name:NIKKI-TAYLOR
Middle Name:
Last Name:DOW
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 1:10210 STROME AVE APT 304
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-4366
Mailing Address - Country:US
Mailing Address - Phone:631-901-3359
Mailing Address - Fax:
Practice Address - Street 1:45 BUSWELL PARK
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-2304
Practice Address - Country:US
Practice Address - Phone:631-901-3359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6654367500000X
MARN2331145163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse