Healthcare Provider Details

I. General information

NPI: 1790610186
Provider Name (Legal Business Name): TAYLOR SUZANNE BOONTJER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4870 WUNNENBERG WAY
WEST CHESTER OH
45069-4863
US

IV. Provider business mailing address

3533 AUBURN DR
REDDING CA
96001-5706
US

V. Phone/Fax

Practice location:
  • Phone: 513-860-4600
  • Fax:
Mailing address:
  • Phone: 513-226-2921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0042442
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: