Healthcare Provider Details

I. General information

NPI: 1053810374
Provider Name (Legal Business Name): TAYLOR ODNEAL ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAYLOR COWELL

II. Dates (important events)

Enumeration Date: 02/02/2018
Last Update Date: 07/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 LAFAYETTE RD
EVANSDALE IA
50707
US

IV. Provider business mailing address

110 CHRISTOPHER CT
FAIRBANK IA
50629-7549
US

V. Phone/Fax

Practice location:
  • Phone: 319-274-7060
  • Fax:
Mailing address:
  • Phone: 319-239-5616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number133794
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA133794
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: