Provider Demographics
NPI:1649088493
Name:TAYLOR, DEMETRIA LORRAINE
Entity type:Individual
Prefix:
First Name:DEMETRIA
Middle Name:LORRAINE
Last Name:TAYLOR
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 1:216 E JOHN ST
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-4217
Mailing Address - Country:US
Mailing Address - Phone:681-389-2454
Mailing Address - Fax:
Practice Address - Street 1:216 E JOHN ST
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-4217
Practice Address - Country:US
Practice Address - Phone:681-389-2454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-26
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant