Provider Demographics
NPI:1154147254
Name:TAYLOR-TAIT, DOMONIQUE (LVN)
Entity type:Individual
Prefix:
First Name:DOMONIQUE
Middle Name:
Last Name:TAYLOR-TAIT
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21270 NICHOLAS AVE
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44123-3029
Mailing Address - Country:US
Mailing Address - Phone:216-785-4768
Mailing Address - Fax:
Practice Address - Street 1:21270 NICHOLAS AVE
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44123-3029
Practice Address - Country:US
Practice Address - Phone:216-785-4768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-23
Last Update Date:2024-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171462164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse