Healthcare Provider Details

I. General information

NPI: 1972980811
Provider Name (Legal Business Name): SIMON MAE TAYLOR FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 E PIKE ST STE 319
SEATTLE WA
98122-3853
US

IV. Provider business mailing address

911 E PIKE ST STE 319
SEATTLE WA
98122-3853
US

V. Phone/Fax

Practice location:
  • Phone: 206-880-3266
  • Fax:
Mailing address:
  • Phone: 206-880-3266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number348621
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60603282
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number823936
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60470931
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: