Provider Demographics
NPI:1396355574
Name:STAPLEY, TAYLOR
Entity type:Individual
Prefix:MS
First Name:TAYLOR
Middle Name:
Last Name:STAPLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 W CAMELOT DR
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-2864
Mailing Address - Country:US
Mailing Address - Phone:928-699-3447
Mailing Address - Fax:
Practice Address - Street 1:1855 W CAMELOT DR
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-2864
Practice Address - Country:US
Practice Address - Phone:928-699-3447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program