Provider Demographics
NPI:1295311389
Name:MORESEA, TAYLOR MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:MARIE
Last Name:MORESEA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22856 SMITH NORTHWEST RD
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-8927
Mailing Address - Country:US
Mailing Address - Phone:570-730-0242
Mailing Address - Fax:
Practice Address - Street 1:22856 SMITH NORTHWEST RD
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-8927
Practice Address - Country:US
Practice Address - Phone:570-730-0242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-20
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.007221RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant