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NPI Code Detail

MEDICARE: TAYLOR MARIE BRYAN

MEDICARE: TAYLOR MARIE BRYAN
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
1164X00000XLicensed Vocational Nurse2056549KY

General Provider Information

NPI Number : 1437894359
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAYLOR MARIE BRYAN
Provider Business Mailing Address
First Line : 10205 EL COCO CT
Second Line :
City : LOUISVILLE
State : KY
Zip : 40291-3531
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3111 CAMINO DEL RIO N STE 1200
Second Line :
City : SAN DIEGO
State : CA
Zip : 92108-5747
Country : US
Telephone Number : 619-209-3696
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2022
Last Update Date : 05/05/2022

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Directions to “ TAYLOR MARIE BRYAN ” Practice Location

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