Healthcare Provider Details

I. General information

NPI: 1598748642
Provider Name (Legal Business Name): COLLEEN TAYLOR FPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 10/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 WATER ST RM 204
WATERVILLE ME
04901-6339
US

IV. Provider business mailing address

PO BOX 587 43 GABRIEL DR
AUGUSTA ME
04332-0587
US

V. Phone/Fax

Practice location:
  • Phone: 207-859-1639
  • Fax: 207-859-1696
Mailing address:
  • Phone: 207-622-7524
  • Fax: 207-621-8393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR1000X
TaxonomyReproductive Endocrinology/Infertility Registered Nurse
License NumberR013536
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: