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General NPI Number Information
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NPI Number | 1912437815
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Entity Type | Individual
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Provider Name | TAYLOR NICOLE CHRISMAN PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/14/2017
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Last Update Date | 05/11/2018
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Provider Practice Location Address
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Address Line | 810 N DIERS AVE
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City | GRAND ISLAND
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State | NE
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Zip | 68803-4955
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Country | US
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Telephone | 308-381-2224
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Fax |
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Provider Business Mailing Address
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Address Line | 501 ROAD G
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City | HENDERSON
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State | NE
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Zip | 68371-8819
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Country | US
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Telephone |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2135
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2135
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License Number State | NE
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