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General NPI Number Information
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NPI Number | 1609530807
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Entity Type | Individual
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Provider Name | TELISA TAYLOR NP
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Gender | Female
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Dates
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Enumeration Date | 10/25/2021
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Last Update Date | 04/14/2022
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Provider Practice Location Address
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Address Line | 199 OAK ST
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City | PEMBROKE
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State | MA
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Zip | 02359-1912
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Country | US
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Telephone | 202-528-7595
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Fax |
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Provider Business Mailing Address
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Address Line | 173 ST PATRICK DRIVE STE 104, #114
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City | WALDORF
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State | MD
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Zip | 20603
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Country | US
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Telephone | 202-528-7595
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | R180238
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License Number State | MD
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