Healthcare Provider Details

I. General information

NPI: 1811191117
Provider Name (Legal Business Name): JEANELLE LUCILLE TAYLOR RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 CAMBRIDGE ST
BRIGHTON MA
02135-2926
US

IV. Provider business mailing address

17 YALE ST
GROVELAND MA
01834-1558
US

V. Phone/Fax

Practice location:
  • Phone: 800-833-1220
  • Fax:
Mailing address:
  • Phone: 978-374-2533
  • Fax: 617-783-0255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0300X
TaxonomyNephrology Registered Nurse
License Number226622
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: