Healthcare Provider Details

I. General information

NPI: 1508498387
Provider Name (Legal Business Name): RANDI NICOLE TAYLOR RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2020
Last Update Date: 02/10/2020
Certification Date: 02/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4697 HARRISON ST STE B
BELLAIRE OH
43906-1338
US

IV. Provider business mailing address

4697 HARRISON ST STE B
BELLAIRE OH
43906-1338
US

V. Phone/Fax

Practice location:
  • Phone: 740-968-7006
  • Fax: 740-968-7256
Mailing address:
  • Phone: 740-968-7006
  • Fax: 740-968-7256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN428841
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: