MEDICARE: MS. MARY L TAYLOR APN

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
1	363LA2200X	Adult Health Nurse Practitioner	209004290	IL

General Provider Information

NPI Number	:	1336472836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY L TAYLOR APN

Provider Business Mailing Address
First Line	:	4501 N WINCHESTER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-5265
Country	:	US
Telephone Number	:	773-250-1078
Fax Number	:	773-250-0497

Provider Business Practice Location Address
First Line	:	4501 N WINCHESTER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-5265
Country	:	US
Telephone Number	:	773-250-1078
Fax Number	:	773-250-0497

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2009
Last Update Date	:	09/15/2009

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