Healthcare Provider Details

I. General information

NPI: 1427768670
Provider Name (Legal Business Name): MS. ASHLEY MICHELLE TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2022
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4847 ERIE ST
BOARDMAN OH
44512-1619
US

IV. Provider business mailing address

4847 ERIE ST
BOARDMAN OH
44512-1619
US

V. Phone/Fax

Practice location:
  • Phone: 330-501-2430
  • Fax:
Mailing address:
  • Phone: 330-501-2430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberCURRENT
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: