Healthcare Provider Details

I. General information

NPI: 1609808328
Provider Name (Legal Business Name): NANCY NUCE TAYLOR NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 02/27/2020
Certification Date: 02/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 E LOUISE DR STE 500
MERIDIAN ID
83642-6305
US

IV. Provider business mailing address

3340 E GOLDSTONE WAY
MERIDIAN ID
83642-1026
US

V. Phone/Fax

Practice location:
  • Phone: 208-706-7050
  • Fax: 208-706-7059
Mailing address:
  • Phone: 208-367-5170
  • Fax: 208-367-5180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberNP721A
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: