Healthcare Provider Details

I. General information

NPI: 1780633768
Provider Name (Legal Business Name): DIANA NILSON-TAYLOR FNP, C.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 N 4TH ST
WILMINGTON NC
28401-3450
US

IV. Provider business mailing address

201 BUCCANEER RD
WILMINGTON NC
28409-2718
US

V. Phone/Fax

Practice location:
  • Phone: 910-343-0270
  • Fax: 910-251-1540
Mailing address:
  • Phone: 910-452-9342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200591
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: