MEDICARE: TRANEISAHA MARIE 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
1	2255A2300X	Athletic Trainer		NV

General Provider Information

NPI Number	:	1477256436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRANEISAHA MARIE TAYLOR

Provider Business Mailing Address
First Line	:	8435 QUARENTINA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-0251
Country	:	US
Telephone Number	:	702-325-9923
Fax Number	:

Provider Business Practice Location Address
First Line	:	8435 QUARENTINA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-0251
Country	:	US
Telephone Number	:	702-325-9923
Fax Number	:

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

Provider Enumeration Date	:	03/27/2023
Last Update Date	:	03/27/2023

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