Provider Demographics
NPI:1558951236
Name:WISNER, TAYLOR LEIGH (DNP, FNP-C, CPNP-PC)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:LEIGH
Last Name:WISNER
Suffix:
Gender:F
Credentials:DNP, FNP-C, CPNP-PC
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:LEIGH
Other - Last Name:WISNER BAROJAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, FNP-C, CPNP-PC
Mailing Address - Street 1:PO BOX 26666
Mailing Address - Street 2:PHS PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:505-841-1063
Mailing Address - Fax:
Practice Address - Street 1:1100 CENTRAL AVE SE
Practice Address - Street 2:PEDIATRIC CARE UNIT
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4930
Practice Address - Country:US
Practice Address - Phone:505-841-1063
Practice Address - Fax:505-724-7042
Is Sole Proprietor?:No
Enumeration Date:2021-01-26
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM80557363LF0000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily