Healthcare Provider Details

I. General information

NPI: 1457178303
Provider Name (Legal Business Name): REBECCA TAYLOR RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9233 RIVERSIDE PKWY APT 5X
TULSA OK
74137-7317
US

IV. Provider business mailing address

9233 RIVERSIDE PKWY APT 5X
TULSA OK
74137-7317
US

V. Phone/Fax

Practice location:
  • Phone: 470-301-5326
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number800318
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: