MEDICARE: MRS. LENEA MARIE TAYLOR RN, MSN

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	363LN0005X	Critical Care Neonatal Nurse Practitioner	670985	TX

General Provider Information

NPI Number	:	1346570793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LENEA MARIE TAYLOR RN, MSN

Provider Business Mailing Address
First Line	:	10910 HILLSDALE LOOP
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-3888
Country	:	US
Telephone Number	:	210-696-1154
Fax Number	:

Provider Business Practice Location Address
First Line	:	5414 FREDERICKSBURG RD STE 100
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3646
Country	:	US
Telephone Number	:	210-541-8281
Fax Number	:

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

Provider Enumeration Date	:	01/07/2010
Last Update Date	:	01/07/2010

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