Provider Demographics
NPI:1386302958
Name:ANDERSON, TAYLOR ANN (NA61214806)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ANN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:NA61214806
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 S NEYLAND AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-8607
Mailing Address - Country:US
Mailing Address - Phone:509-227-9698
Mailing Address - Fax:
Practice Address - Street 1:101 S NEYLAND AVE APT 1
Practice Address - Street 2:
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-8607
Practice Address - Country:US
Practice Address - Phone:509-227-9698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide