Healthcare Provider Details

I. General information

NPI: 1275652463
Provider Name (Legal Business Name): NORTHWEST NEUROLOGY CAROLYN L. TAYLOR, M.D. PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 04/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 BELLWETHER WAY SUITE 210
BELLINGHAM WA
98225-2957
US

IV. Provider business mailing address

11 BELLWETHER WAY SUITE 210
BELLINGHAM WA
98225-2957
US

V. Phone/Fax

Practice location:
  • Phone: 360-752-9919
  • Fax: 360-752-1647
Mailing address:
  • Phone: 360-752-9919
  • Fax: 360-752-1647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number39245
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number39245
License Number StateWA

VIII. Authorized Official

Name: DR. CAROLYN L TAYLOR
Title or Position: OWNER
Credential: MD
Phone: 360-752-9919