Provider Demographics
NPI:1386309144
Name:TAYLOR, LORIBETH (STNA)
Entity type:Individual
Prefix:
First Name:LORIBETH
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 DEFOREST RD SE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-4047
Mailing Address - Country:US
Mailing Address - Phone:234-806-7407
Mailing Address - Fax:
Practice Address - Street 1:4840 EAGLE CREEK RD
Practice Address - Street 2:
Practice Address - City:LEAVITTSBURG
Practice Address - State:OH
Practice Address - Zip Code:44430-9414
Practice Address - Country:US
Practice Address - Phone:234-806-7407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH602345350521376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide