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General NPI Number Information
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NPI Number | 1053810374
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Entity Type | Individual
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Provider Name | TAYLOR ODNEAL ARNP
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Gender | Female
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Dates
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Enumeration Date | 02/02/2018
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Last Update Date | 07/26/2018
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Provider Practice Location Address
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Address Line | 3701 LAFAYETTE RD
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City | EVANSDALE
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State | IA
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Zip | 50707
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Country | US
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Telephone | 319-274-7060
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Fax |
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Provider Business Mailing Address
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Address Line | 110 CHRISTOPHER CT
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City | FAIRBANK
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State | IA
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Zip | 50629-7549
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Country | US
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Telephone | 319-239-5616
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 133794
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | A133794
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License Number State | IA
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