Healthcare Provider Details

I. General information

NPI: 1134313760
Provider Name (Legal Business Name): MARY E TAYLOR C-NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2007
Last Update Date: 08/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CONSTITUTION AVE NE
WASHINGTON DC
20002-6058
US

IV. Provider business mailing address

8256 CEDAR LANDING CT
ALEXANDRIA VA
22306-3237
US

V. Phone/Fax

Practice location:
  • Phone: 202-543-4800
  • Fax: 202-675-0411
Mailing address:
  • Phone: 703-201-4263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN53170
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: