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NPI Code Detail

MEDICARE: ANDREA TAYLOR

MEDICARE:   ANDREA  TAYLOR
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171W00000XContractor

General Provider Information

NPI Number : 1033681333
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA TAYLOR
Provider Business Mailing Address
First Line : 4327 PEACEFUL PATH CT
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89032-0118
Country : US
Telephone Number : 725-500-4764
Fax Number :
Provider Business Practice Location Address
First Line : 4327 PEACEFUL PATH CT
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89032-0118
Country : US
Telephone Number : 725-500-4764
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/26/2018
Last Update Date : 12/26/2018

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Directions to “ ANDREA TAYLOR ” Practice Location

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