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NPI Code Detail

MEDICARE: GARY LEE TAYLOR CRNA

MEDICARE: GARY LEE TAYLOR CRNA
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
1163WC0200XCritical Care Medicine Registered Nurse132736-030WI
2367500000XCertified Registered Nurse Anesthetist3375WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13375OTHERWIWI STATE LICENSE
2132736-30OTHERWIRN WI STATE LICENSE

General Provider Information

NPI Number : 1043275241
Entity Type Code : Individual
Provider Name (Legal Business Name) : GARY LEE TAYLOR CRNA
Provider Business Mailing Address
First Line : 900 ILLINOIS AVE
Second Line :
City : STEVENS POINT
State : WI
Zip : 54481-3114
Country : US
Telephone Number : 715-346-5000
Fax Number :
Provider Business Practice Location Address
First Line : 900 ILLINOIS AVE
Second Line :
City : STEVENS POINT
State : WI
Zip : 54481-3114
Country : US
Telephone Number : 715-346-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2006
Last Update Date : 06/07/2012

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