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NPI Code Detail

MEDICARE: TAYLOR LAVENDER PMHNP-BC

MEDICARE: TAYLOR LAVENDER PMHNP-BC
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner4704359553MI
2363LP0808XPsychiatric/Mental Health Nurse PractitionerCAPN0003600CNCO

General Provider Information

NPI Number : 1952936494
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAYLOR LAVENDER PMHNP-BC
Provider Business Mailing Address
First Line : 3487 BLUE LICK RD
Second Line :
City : WINFIELD
State : WV
Zip : 25213-7729
Country : US
Telephone Number : 304-389-0312
Fax Number :
Provider Business Practice Location Address
First Line : 10300 SW EASTRIDGE ST
Second Line :
City : PORTLAND
State : OR
Zip : 97225-5004
Country : US
Telephone Number : 503-944-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2020
Last Update Date : 09/13/2022

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