Healthcare Provider Details

I. General information

NPI: 1689891905
Provider Name (Legal Business Name): STACIA L TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 07/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 EXEMPLA CIR OPTICAL DISPENSING
LAFAYETTE CO
80026-3370
US

IV. Provider business mailing address

280 EXEMPLA CIR OPTICAL DISPENSING
LAFAYETTE CO
80026-3370
US

V. Phone/Fax

Practice location:
  • Phone: 720-536-6669
  • Fax:
Mailing address:
  • Phone: 720-536-6669
  • Fax: 720-536-6670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: