Healthcare Provider Details

I. General information

NPI: 1427753037
Provider Name (Legal Business Name): MARY TAYLOR REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 04/03/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1481 W 10TH ST
INDIANAPOLIS IN
46202-2803
US

IV. Provider business mailing address

951 N KEALING AVE
INDIANAPOLIS IN
46201-2523
US

V. Phone/Fax

Practice location:
  • Phone: 317-554-0000
  • Fax: 317-988-5385
Mailing address:
  • Phone: 815-529-9196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number041470258
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: