Provider Demographics
NPI:1336200724
Name:TAYLOR, TAMMY (RN)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6737 W WASHINGTON ST
Mailing Address - Street 2:SUITE 1111
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53214-5647
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6737 W WASHINGTON ST
Practice Address - Street 2:SUITE 1111
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53214-5647
Practice Address - Country:US
Practice Address - Phone:414-302-9175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI139416030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38270700Medicaid