Provider Demographics
NPI:1083002919
Name:TAYLOR, DOREEN ANN (CNA)
Entity type:Individual
Prefix:
First Name:DOREEN
Middle Name:ANN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 RIDGEVIEW PL
Mailing Address - Street 2:
Mailing Address - City:WILLINGBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08046-4007
Mailing Address - Country:US
Mailing Address - Phone:706-453-6813
Mailing Address - Fax:
Practice Address - Street 1:19 RIDGEVIEW PL
Practice Address - Street 2:
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-4007
Practice Address - Country:US
Practice Address - Phone:706-453-6813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-30
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0028658428374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACN0028658428OtherCERTIFIED NURSES AID