Healthcare Provider Details

I. General information

NPI: 1295327617
Provider Name (Legal Business Name): TAYLOR ELIZABETH SMITH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2021
Last Update Date: 02/08/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 VICTORIA ST # VB360A
PITTSBURGH PA
15213-2543
US

IV. Provider business mailing address

102 HIGHLAND AVE
MONACA PA
15061-2619
US

V. Phone/Fax

Practice location:
  • Phone: 888-747-0794
  • Fax:
Mailing address:
  • Phone: 724-494-9323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN683169
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: