Healthcare Provider Details

I. General information

NPI: 1124338637
Provider Name (Legal Business Name): MS. VONDA JEAN TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2010
Last Update Date: 10/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1988 HIGHWAY 34 LOT 19
WEST MONROE LA
71292-0488
US

IV. Provider business mailing address

1988 HIGHWAY 34 LOT 19
WEST MONROE LA
71292-0488
US

V. Phone/Fax

Practice location:
  • Phone: 318-512-6795
  • Fax:
Mailing address:
  • Phone: 318-512-6795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: