MEDICARE: MRS. SOPHIA NORMA 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	363LP0200X	Pediatric Nurse Practitioner	209003716	IL

General Provider Information

NPI Number	:	1568497162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SOPHIA NORMA TAYLOR APN

Provider Business Mailing Address
First Line	:	2525 W FARWELL AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-4617
Country	:	US
Telephone Number	:	773-761-3109
Fax Number	:

Provider Business Practice Location Address
First Line	:	1725 S WABASH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-1219
Country	:	US
Telephone Number	:	312-922-2777
Fax Number	:

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	03/17/2018

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