Healthcare Provider Details

I. General information

NPI: 1457476392
Provider Name (Legal Business Name): ALICIA A TAYLOR RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 10/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 SW 4TH AVE
MILTON FREEWATER OR
97862-1031
US

IV. Provider business mailing address

110 SW 4TH AVE
MILTON FREEWATER OR
97862-1031
US

V. Phone/Fax

Practice location:
  • Phone: 509-301-5696
  • Fax:
Mailing address:
  • Phone: 509-301-5696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number200540121RN
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number200540121RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: