Provider Demographics
NPI:1831415173
Name:TAYLOR, SUSAN CAROLINE (RN)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:CAROLINE
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 1:136 OHIO AVE
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-1774
Mailing Address - Country:US
Mailing Address - Phone:330-990-3187
Mailing Address - Fax:
Practice Address - Street 1:136 OHIO AVE
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-1774
Practice Address - Country:US
Practice Address - Phone:330-990-3187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN189775163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse