Healthcare Provider Details

I. General information

NPI: 1467043661
Provider Name (Legal Business Name): TAYLOR LEIGH PACHECO FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2021
Last Update Date: 01/30/2021
Certification Date: 01/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 DAN RD # 45
CANTON MA
02021-2852
US

IV. Provider business mailing address

117 STACKHOUSE ST APT 1
SOUTH DARTMOUTH MA
02748-1905
US

V. Phone/Fax

Practice location:
  • Phone: 781-867-2050
  • Fax:
Mailing address:
  • Phone: 508-496-7451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2308257
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: