=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659667491
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEGAN LANE TAYLOR APRN-CNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/20/2011
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1520 S MAIN ST STE 2
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45409-2643
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-461-5815
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1100 TAYWOOD RD APT 62
-----------------------------------------------------
City | ENGLEWOOD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45322
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-641-9124
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | 020918
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------