Healthcare Provider Details

I. General information

NPI: 1457642654
Provider Name (Legal Business Name): COLLEEN MARIE TAYLOR APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2011
Last Update Date: 04/23/2021
Certification Date: 04/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 TSIENNETO RD STE 300
DERRY NH
03038-1584
US

IV. Provider business mailing address

6 TSIENNETO RD STE 300
DERRY NH
03038-1584
US

V. Phone/Fax

Practice location:
  • Phone: 603-216-0400
  • Fax: 603-216-0400
Mailing address:
  • Phone: 603-216-0400
  • Fax: 603-216-0400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number063403-21
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number063403-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: