Healthcare Provider Details

I. General information

NPI: 1679676852
Provider Name (Legal Business Name): ANN M TAYLOR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 S 140TH CIR
OMAHA NE
68144-2315
US

IV. Provider business mailing address

2505 S 140TH CIR
OMAHA NE
68144-2315
US

V. Phone/Fax

Practice location:
  • Phone: 402-345-6161
  • Fax: 402-345-2827
Mailing address:
  • Phone: 402-345-6161
  • Fax: 402-345-2827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number13577
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: