Healthcare Provider Details

I. General information

NPI: 1154041879
Provider Name (Legal Business Name): TAYLOR BEIRNE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2022
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7603 WEST NORTH AVENUE
RIVER FOREST IL
60305
US

IV. Provider business mailing address

3614 N FREMONT ST APT 2
CHICAGO IL
60613-4372
US

V. Phone/Fax

Practice location:
  • Phone: 708-456-7787
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209025860
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209025860
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: