Healthcare Provider Details

I. General information

NPI: 1548090665
Provider Name (Legal Business Name): TAYLOR NICOLE SEIVERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2024
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 BELMONT AVE
YOUNGSTOWN OH
44504-1006
US

IV. Provider business mailing address

319 3RD ST
LOWELLVILLE OH
44436-1274
US

V. Phone/Fax

Practice location:
  • Phone: 330-559-7792
  • Fax:
Mailing address:
  • Phone: 330-559-7792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0021547
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: