Healthcare Provider Details

I. General information

NPI: 1033937362
Provider Name (Legal Business Name): ALEXA M TAYLOR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2024
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 BRUNSWICK ST
OLD TOWN ME
04468-1613
US

IV. Provider business mailing address

PO BOX 1599
BANGOR ME
04402-1599
US

V. Phone/Fax

Practice location:
  • Phone: 207-404-8100
  • Fax:
Mailing address:
  • Phone: 207-404-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP241601
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: