Healthcare Provider Details

I. General information

NPI: 1528936127
Provider Name (Legal Business Name): TAYLOR SKJORDAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2025
Last Update Date: 10/27/2025
Certification Date: 10/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 REICHELDERFER RD
CRIDERSVILLE OH
45806-2236
US

IV. Provider business mailing address

301 REICHELDERFER RD
CRIDERSVILLE OH
45806-2236
US

V. Phone/Fax

Practice location:
  • Phone: 701-520-4223
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.009875RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: