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General NPI Number Information
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NPI Number | 1821353038
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Entity Type | Individual
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Provider Name | KARA TAYLOR-BOURNE MSED
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Gender | Female
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Dates
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Enumeration Date | 07/13/2012
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Last Update Date | 07/11/2013
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Provider Practice Location Address
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Address Line | 217 BEACH 90TH ST APT 3
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City | ROCKAWAY BEACH
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State | NY
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Zip | 11693-1501
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Country | US
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Telephone | 917-683-8340
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Fax |
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Provider Business Mailing Address
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Address Line | 217 BEACH 90TH ST APT 3
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City | ROCKAWAY BEACH
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State | NY
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Zip | 11693-1501
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Country | US
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Telephone | 917-683-8340
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 618283121
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License Number State | NY
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