Healthcare Provider Details

I. General information

NPI: 1669344834
Provider Name (Legal Business Name): TAYLOR J HAUN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2025
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 BROADWAY
BANGOR ME
04401-3337
US

IV. Provider business mailing address

360 US HIGHWAY 1 BYP UNIT 102
PORTSMOUTH NH
03801-7105
US

V. Phone/Fax

Practice location:
  • Phone: 207-922-1300
  • Fax: 207-217-6742
Mailing address:
  • Phone: 603-319-4490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2962
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: