Healthcare Provider Details

I. General information

NPI: 1699940189
Provider Name (Legal Business Name): NAN R TAYLOR CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2008
Last Update Date: 04/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 JOHNS HOPKINS DR
GREENVILLE NC
27834-7222
US

IV. Provider business mailing address

850 JOHNS HOPKINS DR
GREENVILLE NC
27834-7222
US

V. Phone/Fax

Practice location:
  • Phone: 252-752-5227
  • Fax: 252-752-1191
Mailing address:
  • Phone: 252-752-5227
  • Fax: 252-752-1191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberNC160
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: