Healthcare Provider Details

I. General information

NPI: 1972176022
Provider Name (Legal Business Name): ELIZABETH ANNE TAYLOR SDNP, SWHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2021
Last Update Date: 07/16/2021
Certification Date: 07/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2354 LEDA LN
SANTA CLARA UT
84765-5666
US

IV. Provider business mailing address

2354 LEDA LN
SANTA CLARA UT
84765-5666
US

V. Phone/Fax

Practice location:
  • Phone: 801-638-7826
  • Fax:
Mailing address:
  • Phone: 801-638-7826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number4924273-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: