Healthcare Provider Details

I. General information

NPI: 1164940649
Provider Name (Legal Business Name): MARQUITA M TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARQUI TAYLOR

II. Dates (important events)

Enumeration Date: 09/05/2017
Last Update Date: 09/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2304 N 51ST STREET
PHILADELPHIA PA
19131-1913
US

IV. Provider business mailing address

2304 N 51ST STREET
PHILADELPHIA PA
19131
US

V. Phone/Fax

Practice location:
  • Phone: 267-575-9543
  • Fax: 267-575-9543
Mailing address:
  • Phone: 267-575-9543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: