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General NPI Number Information
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NPI Number | 1861897456
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Entity Type | Individual
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Provider Name | STACEY MARIE TAYLOR CRNP, MSN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 10/26/2014
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Last Update Date | 08/17/2015
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Provider Practice Location Address
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Address Line | 25 CHURCH ST
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City | WILKES BARRE
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State | PA
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Zip | 18765-0999
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Country | US
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Telephone | 570-441-6262
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Fax |
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Provider Business Mailing Address
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Address Line | 1659 FAIRVIEW AVE
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City | BERWICK
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State | PA
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Zip | 18603-2512
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Country | US
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Telephone | 570-441-6262
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NOT AVAILABLE
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License Number State | PA
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