MEDICARE: MRS. NICOLE M TAYLOR STNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	401843590416	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	401843590416	OTHER	OH	STNA REGISTRY

General Provider Information

NPI Number	:	1235742834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NICOLE M TAYLOR STNA

Provider Business Mailing Address
First Line	:	899 CHESTER AVE
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44314-2807
Country	:	US
Telephone Number	:	330-328-9025
Fax Number	:

Provider Business Practice Location Address
First Line	:	899 CHESTER AVE
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44314-2807
Country	:	US
Telephone Number	:	330-328-9025
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2020
Last Update Date	:	08/25/2020

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