Healthcare Provider Details

I. General information

NPI: 1669836771
Provider Name (Legal Business Name): TAYLOR CLEARY JUNOD CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2016
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 WALNUT ST STE 603
PHILADELPHIA PA
19102-3516
US

IV. Provider business mailing address

4527 E THOMPSON ST
PHILADELPHIA PA
19137-2003
US

V. Phone/Fax

Practice location:
  • Phone: 267-754-8400
  • Fax:
Mailing address:
  • Phone: 215-535-1275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ15395800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number312432
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLP0010799
License Number StateDE
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR268993
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberSP015859
License Number StatePA
# 6
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP015859
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: