Healthcare Provider Details

I. General information

NPI: 1588866560
Provider Name (Legal Business Name): LA TONYA RENEE TAYLOR CNA1
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LA TONYA RENEE TAYLOR CNA2

II. Dates (important events)

Enumeration Date: 06/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 PEGG AVE
KERNERSVILLE NC
27284-2433
US

IV. Provider business mailing address

125 PEGG AVE
KERNERSVILLE NC
27284-2433
US

V. Phone/Fax

Practice location:
  • Phone: 336-995-7816
  • Fax: 336-996-2594
Mailing address:
  • Phone: 336-995-7816
  • Fax: 336-996-2594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number55183
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: