Healthcare Provider Details

I. General information

NPI: 1750327508
Provider Name (Legal Business Name): DEBRA N TAYLOR CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 07/19/2021
Certification Date: 07/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 STANAFORD RD
BECKLEY WV
25801-3142
US

IV. Provider business mailing address

ONE VIRGINIA AVENUE SUITE 201
PROVIDENCE RI
02905
US

V. Phone/Fax

Practice location:
  • Phone: 304-255-3000
  • Fax: 304-255-3544
Mailing address:
  • Phone: 401-490-0916
  • Fax: 401-490-0979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number584742
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number87006
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: