MEDICARE: BEVERLY S TAYLOR CRNA

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	367500000X	Certified Registered Nurse Anesthetist	035726	NC

General Provider Information

NPI Number	:	1740282540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEVERLY S TAYLOR CRNA

Provider Business Mailing Address
First Line	:	2648 BUCKINGHAM DR
Second Line	:
City	:	SANFORD
State	:	NC
Zip	:	27330-9372
Country	:	US
Telephone Number	:	919-718-6858
Fax Number	:

Provider Business Practice Location Address
First Line	:	1135 CARTHAGE ST
Second Line	:
City	:	SANFORD
State	:	NC
Zip	:	27330-4162
Country	:	US
Telephone Number	:	919-774-2100
Fax Number	:

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	07/08/2007

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