MEDICARE: MRS. LORRAINE SULLIVAN TAYLOR APRN

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	363L00000X	Nurse Practitioner	000614	CT

General Provider Information

NPI Number	:	1699728048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LORRAINE SULLIVAN TAYLOR APRN

Provider Business Mailing Address
First Line	:	39 BROOKLINE AVE
Second Line	:
City	:	HIGGANUM
State	:	CT
Zip	:	06441-4200
Country	:	US
Telephone Number	:	860-345-3322
Fax Number	:

Provider Business Practice Location Address
First Line	:	39 BROOKLINE AVE.
Second Line	:
City	:	HIGGANUM
State	:	CT
Zip	:	06441
Country	:	US
Telephone Number	:	860-345-3322
Fax Number	:

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

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	05/12/2008

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