1598748642 NPI number — MS. COLLEEN TAYLOR FPNP

Table of content: MS. COLLEEN TAYLOR FPNP (NPI 1598748642)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598748642 NPI number — MS. COLLEEN TAYLOR FPNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAYLOR
Provider First Name:
COLLEEN
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
FPNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598748642
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 587
Provider Second Line Business Mailing Address:
43 GABRIEL DR
Provider Business Mailing Address City Name:
AUGUSTA
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04332-0587
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-622-7524
Provider Business Mailing Address Fax Number:
207-621-8393

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
97 WATER ST
Provider Second Line Business Practice Location Address:
RM 204
Provider Business Practice Location Address City Name:
WATERVILLE
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04901-6339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-859-1639
Provider Business Practice Location Address Fax Number:
207-859-1696
Provider Enumeration Date:
11/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WR1000X , with the licence number:  R013536 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 999001008 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com