Provider Demographics
NPI:1104174101
Name:TAYLOR, GRACE (RN, MA, CHC)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:RN, MA, CHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8103 FAWN CT
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-1947
Mailing Address - Country:US
Mailing Address - Phone:240-388-5396
Mailing Address - Fax:
Practice Address - Street 1:8103 FAWN CT
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-1947
Practice Address - Country:US
Practice Address - Phone:240-388-5396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-22
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY59393011133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist