=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548677925
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ZITA REMENE TAYLOR-LORQUET LPN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2014
-----------------------------------------------------
Last Update Date | 07/17/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 61 GRASSLANDS RD
-----------------------------------------------------
City | VALHALLA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10595
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-681-8500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 125 - PONINGO STREET #3
-----------------------------------------------------
City | PORT CHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10573
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-258-4130
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number | 282727
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------