Provider Demographics
NPI:1982465019
Name:TAYLOR, JACQUELYNN ROWENA
Entity Type:Individual
Prefix:
First Name:JACQUELYNN
Middle Name:ROWENA
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 1:1550 E 74TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-2614
Mailing Address - Country:US
Mailing Address - Phone:907-929-5826
Mailing Address - Fax:
Practice Address - Street 1:130 S WILLOW ST STE 9
Practice Address - Street 2:
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-9107
Practice Address - Country:US
Practice Address - Phone:907-283-0085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant