Healthcare Provider Details

I. General information

NPI: 1477934958
Provider Name (Legal Business Name): MRS. ALLISON JEANETTE TAYLOE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2015
Last Update Date: 09/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 WYOMING ST
DAYTON OH
45409-2731
US

IV. Provider business mailing address

122 WYOMING ST
DAYTON OH
45409-2731
US

V. Phone/Fax

Practice location:
  • Phone: 937-223-4461
  • Fax: 937-449-7603
Mailing address:
  • Phone: 937-223-4461
  • Fax: 937-449-7603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number350154
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: