Healthcare Provider Details

I. General information

NPI: 1447356035
Provider Name (Legal Business Name): VANESSA HENDERSON TAYLOR BS, RRT, RCP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6494 WINDY CREEK WAY
FAYETTEVILLE NC
28306-8910
US

IV. Provider business mailing address

6494 WINDY CREEK WAY
FAYETTEVILLE NC
28306-8910
US

V. Phone/Fax

Practice location:
  • Phone: 910-425-6171
  • Fax:
Mailing address:
  • Phone: 910-425-6171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279G1100X
TaxonomyGeneral Care Registered Respiratory Therapist
License Number935
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: