Healthcare Provider Details

I. General information

NPI: 1053526269
Provider Name (Legal Business Name): LOIS JANE TAYLOR CANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LOIS JANE TAYLOR CNP

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 08/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 E MARKET ST
LOGANSPORT IN
46947-2295
US

IV. Provider business mailing address

3400 E MARKET ST
LOGANSPORT IN
46947-2295
US

V. Phone/Fax

Practice location:
  • Phone: 574-722-9366
  • Fax: 574-722-5987
Mailing address:
  • Phone: 574-722-9366
  • Fax: 574-722-5987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71001445A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: