Healthcare Provider Details

I. General information

NPI: 1376377937
Provider Name (Legal Business Name): TAYLOR CELESTE DAGNON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2024
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2360 E PERSHING BLVD
CHEYENNE WY
82001-5356
US

IV. Provider business mailing address

13619 COUNTY ROAD 114
CARR CO
80612-9021
US

V. Phone/Fax

Practice location:
  • Phone: 307-775-7708
  • Fax:
Mailing address:
  • Phone: 970-815-1272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number1684764
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: