MEDICARE: MARIAN TAYLOR RN

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	163WG0000X	General Practice Registered Nurse	717299	TX

General Provider Information

NPI Number	:	1518795616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIAN TAYLOR RN

Provider Business Mailing Address
First Line	:	750 W TRAVIS ST
Second Line	:
City	:	LA GRANGE
State	:	TX
Zip	:	78945-2522
Country	:	US
Telephone Number	:	979-968-3711
Fax Number	:

Provider Business Practice Location Address
First Line	:	750 W TRAVIS ST
Second Line	:
City	:	LA GRANGE
State	:	TX
Zip	:	78945-2522
Country	:	US
Telephone Number	:	979-968-3711
Fax Number	:

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

Provider Enumeration Date	:	07/22/2024
Last Update Date	:	07/23/2024

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