Healthcare Provider Details

I. General information

NPI: 1548187826
Provider Name (Legal Business Name): TAYLOR MARIE WELBORN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 8721
SURPRISE AZ
85374-0128
US

IV. Provider business mailing address

15126 N 182ND LN
SURPRISE AZ
85388-7621
US

V. Phone/Fax

Practice location:
  • Phone: 480-528-3208
  • Fax:
Mailing address:
  • Phone: 480-528-3208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: